1985, 05-08 Permit App: 00005787 ResidenceBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
130
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Na (last) (first) (m) Use Only
/� IDapedtrent
l 1 ��.ry w. : R39. U IComm
2 Project Address (not Mailing Address) cr Road Name `\ Space Zip
E. lo(o icm Nc\mcAn cici1CCn
3 CCIty/Comm(unity
o)cA.N2
State
Subdivision/Plat Name ( �/� ` }
A' 1 e i 1 r • li CK.1 I '
i75 l _ i 1 6-7
�T��
Lot
. 'I
Black
* •. * DEPARTMENT USE ONLY * * *
5 Sic Cade
Zone Act. If
Zone
Msu
Project No
6.187
6 Dwell M
l,.
No. of Buildings
1
Sq Ft./Acre
Depth
Iva :)c"
Frontage
3Z3`
7 Set Back -Fr t
5b�
(L S-1
.1Eb,
(R)S-2 1 Rear
So f ZS t
Census Tract
Census
Modula No.
Inc
z—.}
16 Architect Firm Name I Stre
\— e-' 1 n 9\\\cine
1 Address {�
!t : IOIc\ 1';�
Zip City
9 C at CD Spflk-ar\D
State
Wa
Phone
( ) 9 a_.ca--7o9G.
Contac Person `
ma1c\ \S{'_nV\C�1s • •
Phone If different than above
( )
Contractor Firm Name
\o`kh VIPil. AQ s* CO. -Tin c.
Street
Address
S. 6aCG Roos 12 CO.
Zip /
g
s3 -0(a
City
�
pon1ND
State
(Th. -
Phone
( ) 91i -0p - ag81
Contact Person (,
\ )Ck -L R rtOm
License No. c co 1
R 0-71-M C.'& a o3 06
Phone if different than above
( )
\
8 Owner/Agent (If different than /11 above)
Business
Address
9 Zip
City
State
Phone
( 1
12 Review Required
Plan Check (Y/N)
Other (YIN)
I SEPA Exempt
(Y/N)
Date
15 Type Work /Bldg
0 Fire
❑ MH
0 Demo
❑ New
0 Add/Alter
0 Replace
0 Move
0 Other
14 Describe Work /
�er-S (`t . t.)n u- 1 CZ -PCYLiaCaj
10 Applicant Name
Street
Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
tion
Atldi4 eTlZ 11matl�F 1� Decg_
-77o4) um
• s,.g 4 CtfrL
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
Environmental Health
W. 1101 College
Room 200
Conditions/Comments.
DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required in either "release' or 'release with conditions"
space prior to permit issuance.)
❑ Commercial;
❑ New Construction;
❑ Additional structure;
❑ Residential
0 Bldg alteration/addition
APPLICATION ff 5 e V/ /
At f4 .9
Release
Release
w/cond 1
Hold 2
GI,wi`
r�
'rev.
r
Planning/Zoning:
N. 721 Jefferson
❑ Commercial; 0 Cert. of Exemption; 0 Frontage;
❑ Setbacks; 0 lot w/d; 0 lot size; 0 use/zone.
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions /Comrrients•
Engineers:
N. 811 Jefferson
Conditions /Com men is•
❑ Commercial;
❑ drainage
❑ road improvements
❑ Residential;
❑ new access/approach;
❑ Flood Plain;
O fence; t
tWA - 0737
Utilities:
N. 811 Jefferson .".
Conditions/ Comments •
Other:
Plan
Fire
Cond
Exam
1/24//8
l
•
'rev.
CP\ CD
Project Representative Telephone
Agencies Performing Special Inspection:
1
2 1
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
,7
. J' C ET LZIFORATIC?1
/FILM 3210 E. Amity
i/ P.O. BOX 7923 • BOISE, IDAHO 83707
A/C 208/376-8934
MARV ASKEY
V* m,., 4-e ✓
i 1
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t t 1
1
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f #v .4 Alel -A; On
1 E. iO6'a hiftI•r,a",
JOB NAME: JOB -#
LOCATION: •
SALESMAN: BY DATE:
- -'SHEET -
---OF •