1985, 03-27 Permit App: 00004659 PoolBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (last) ) / (ffiir-sstt)y (m)
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DepertrrentlAB Only
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Comm
2 Project Address (not Mailing Address) or Road Name Space Zip
S' 7/ . 6 S4 ?9Li 2---
3
3 City/Community
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State
Zg- —
Subdivision/ Plat Name
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4 Assessor Parcel No.
/ 9s -c3 - 07.D Z-
Lot
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Block
/
r * : DEPARTMENT USE ONLY * *
5' Sic Code
Zone Act. a
Zana yt ^` ' g
,r/"Ul3` CJ
Project No. ^16L/. !
•...13DweDwell./No.
of Buildings
1
Sq. Ft./Acre
Depthc-F
'
Frontage
7 f Ct�`N I(L
(R)S-2 aCensus
Tract
Module No.
Inillelyau
C
18 Architect Firm Name Street Address
Zip
Gy
State
Phone
1 1
Contact Person
Phone it different than above
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Street Address 3-n
G/Phone
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/Zip C `-7 4
City ^o/ 6_
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States..
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COQ 6
' /act PersonL??7L� L'
L WZ R `f/�( C.7°.—
Phona, iu1 d-Ilr/1fNeerent than above
8 Owner/Agent (If different than 4/1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N)
SEPA Exempt (Y/N)
Date
15 Type Work 0 Bldg
.❑ Fire
0 MH
0 Demo
eNew
0 Add/Alter
0 Replace
0 Move
'rather
14 Describe Work :
5/2- 0 Swimmi Na Pool -
10 Applicant Name
Street Address
11 Zip -
City
State
Phone
( )
Lender
Street Address
Zlp
City
State
Phone
( )
Contact Person ..
Phone if different than above
( )
Additional Information
1
DEPARTMENT APPROVALS
1 Indicate above or attach conditions relative to final as built approval
2 indicate above or attach reasons for hold
This is nota Permit
Application Type
(Standard unless
otherwise Indicated)
(Indicated approvals required In either "release" or "release with conditions"
space prior to permit issuance.)
❑
Fast Track
Early Start
Release
Release
w/cond 1
Hold 2
Environmental Health 0 Commercial; 0 Residential
W. 1101 College 0 New Construction; ❑ Bldg alteration /addition
Room 200 0 Additional structure;
01 4.
,
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APPLICATION #
1} Wa(S
Conditions/Comments. TT ll
•
Planning/zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone•
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
%
Conditions/Comments.
El
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence;
❑ road Improvements
Conditions/Comments
•
Utilities:
N. 811 Jefferson
Conditions/ Comments •
Other:
Plan Exam
Fire Prev.
Conditions/Comments
Project Representative Telephone
Agencies Performing Special Inspection:
1
IInformati
2
3
1 Indicate above or attach conditions relative to final as built approval
2 indicate above or attach reasons for hold
6-16
36
36
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