HomeMy WebLinkAbout1985, 06-12 Permit: 00005886 AdditionBUILDING 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)
(first)
(m)
Department use Only
Res. Comm
2 Project Address (not Mailing Address) or Road Name
Space
Zip
3 City/Community
LiY��ur
State
Subdivision/ Plat Name 1
1 C_
4 Assessor Parcel No.
6 � � ... O � `
I
Lot
1,;�
Block
* * * DEPARTMENT USE ONLY
5 Sic Code
Zone Act. N
J
Zone )
114
Project
No.
6 Dwell MNo.
j
of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Back -Front
�
(L)S-1
(R)S-2
s
Rear
Census Tract
Module No.
Initials
16 Architect Firm Name
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 N1 above)
Business Address
g Zip
City
State
1
Phone
! ( )
12 Review Required
Plan Check (YIN)
Other (YIN)
SEPA Exempt (YIN)
Date
15 Type Work CJ Bldg
❑ Fire
❑
❑
MH
IN
C New
IAAdd/Alter
❑ Replace
❑ Move
❑ Other
I-
14 Describe Work
o) o��
10 Applicant Name
Street Address
11 Zip
City
State
Phone
l )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
Additional Information
11
DEPARTMENT APPROVALS
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
Application Type
i nis is not a Permit '
❑
(Standard unless
otherwise indicated)
Fast Track
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
❑
Early Start
Release
Release w/cond 1 Hold 2
Environmental Health
W. 1101 College
❑ Commercial; ❑ Residential
❑ New Construction; ❑ Bldg alteration/addition
Room 200
V Additional structures;
APPLICATION #�_1 1��7
Conditions IComments:
❑
Planning/ Zoning:
❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;�
N. 721 Jefferson
❑ Setbacks; El lot w/d; El lot size; Eluse/zone; L -L:==
❑ CU, variance, zone change; shoreline; ❑ fence;
❑ Other
Conditions/ Comments:
❑Engineers:
❑ Commercial; ElResidential; ❑ Flood Plain;
N. 811 Jefferson
❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/ Comments:
❑
Utilities:
N. 811 Jefferson
Conditions/ Comments:
❑
Other:
❑
Pian Exam
Fire Prev.
Conditions/ Comments:
Project Representative
Telephone
Agencies Performing Special Inspection:
C
O
1.
E
2
0
C
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
GARAGE EXISTING
- 24- — --
EXISTING CONCRETE T
DRIVEWAY AND
WALK
18
2
DRAIN FIELD
EXISTING
PLOT PLAN FOR DAVE HOOVER N
N 2802 JOEL ROAD -
SCALE 1/16 IN a 1 FOOT
ALL DIMENSIONS IN FEET
24
SEPTIC TANK
EXISTING PROPOSED EXPANSION
12 X 23 EXTRA ROOM
WITH 5 X 5 ENTRY NAY
7:5
- - - 23 --y
3i
5�,- 5 12
s 5
s
h----- 28 ---
--- - --- -- 48
24 HOUSE EXISTING 1S
I � �
3
EXISTING WALK
S3.4 - - -
30
128