1984, 08-24 Permit App: 00001930 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 Ow er' Name
(last)
Spr(ai5er
2 Project Address (not Mailing Address) v Name
Rao c0 C, ' ,'t Dr.
/q
)
(m)
k1
apartment Use Only /V?O
F. Comm
Space
Zip
9.9 2-}
3 City/Community
4 Assessor Parcel No
2'i 54f4 — (cJo
State
Lot
Block
9
Subdivision/ Plat Name
tHie4tRi- AC, 24\io
* * DEPARTMENT USE ONLY * * *
5 Sic Code
Zone Act.*
Zone
5 pry
Project No.
6 Dwell
No. of Buildings
Sq. Ft./Acre
Depth
I21i
Frontage
7 Set Bark-Front(L)S-1
E_xr9fl� (of
(R)s-;
Rear
Census Tract
Module No
Initials
Jo 11/41 m
16 Architect Firm Name I Street Address
Zip
City
State
Phone
)
Contact Person
Phone if different than above
)
Contractor Firm Name
Street Address
Zip
City State
Phone
Contact Person
License No.
Phone if different than above
8 Owner/Agent (if different than e1 above)
Business Address
9 Zip
City
State
Phone
)
12 Review Required
Plan Check (Y/ N)
Other (YIN) SEPA Exempt (Y/N)
Date
15 Type Work
❑ Bldg
O Flre
❑ MH
O Demo
❑ New
O Add/Alter
Replace'
❑ Move
0 Other
14 Describe Work
« •(/
• � ../`� � 7 �% . . �CJ(Yn'w. � �+:�,: - ii-crf S rit-DUL_ 6'Y6 l...w(J\
Street Address
(3zo(0 ct� Yf Dr,
10 Applicant Name i6Yl es �� So V t tn.4 GY
C(%
City
S)pe %C 4
11 Zip
State
CA-9C%
Phone
)c,'/`/
Lender
Street Address
Zip
City
State
Phone
Contact Person
Phone If different than above
( 1
Additional Information
•
•
T
DEPARTMENT APPROVALS
❑
❑
Application Type
(Standard unless
otherwise Indicated)space
Fast Track
Early Start
1 nis is nota rermit
(Indicated approvals required in either "release" or "release with conditions"
prior to permit issuance.)
Release
Release
w/cond 1
Hold 2
d_
Environmental Health O Commercial; 0 Residential
W. 1101 College 0 New Construction; ❑ Bldg alterationladdition
.
� �
: ��� a'
,�
Room 200 0 Additional structure;
Pit
APPLICATION 1/
" /76.) 9i
Conditions/Com ments•
0
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; ti
0 Other
Condltions/Comments'
•
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 fence;
•❑ new access/approach;
❑ road improvements
Conditions /Comments'
•
Utilities:
N. 811 Jefferson
Conditions/Comments'
•
Other:
•
Plan Exam
Fire Prev.
Conditions /Comments'
IInformation 01
Project Representative Telephone
Agencies Performing Special Inspection:
1
2
3 •
1 Indicate above of attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
5- •
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