1984, 12-17 Permit App: 00003749 ResidenceBUILDING 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 (Inst) (first) (m)
Vo il-r a 1Yi Mi (ill el D.
Department y6a Only
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Comm
2 Project Address (not Mailing Address) Cr Road Name Space Zip
S. 3Ci=iCDC1 LOR"EE-li P. -DR-.
3 City/Community
nl'
State
'Tn ,
Subdivision/Plat
ITh d
Name
• •r, e rd. Addition
4 Assessor Parcel No.
_ z4 V Q
��s� /
Lot
c?lr,nE 1
Block
II (fmi l
* * it DEPARTMENT USE ONLY * * it
/
5 Sic Code
Ions Act. M
Zone
Project No. _ .� "
�4`:1
6 Dwell It
No. of Buildings
Sq. Ft./Acre
Depth • h
Frontage l
7 Set Back -Front
l
(L)S-1
(R)S-2
l Rear
Census Tract
Module No.
Inittwi
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone If different than above
( )
Contractor Firm Name
?;gip h.as�l. D_ P"r•Grr,t-,. Conti-,� -; nn
Street Address
: - )r ,(2)1 -Ian Marter
City
99206. <�nolrf ,-P
State
ra _
(�(�;0) R; F'-1097
Contact Person
.
License No.
r
I c— r—Am— J2 2 DC
Phone If different than above
( )
8 Owner/Agent (if different than 61 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (Y/N)
Other (Y/N) 1SEPAExempt(Y/N)
Date
15 Type Work ❑ Bkig
❑ Fire
❑ MH
❑ Demo
xf] New
❑ Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work
3i_1-1,Mle fainly dwelling
pJ�
10 AP l C1nc �d e1 D. c i r t'1
steet Addrer i; 'V..n ',al -ter
11 Zip
City,
State
Phone7
r' C
a s ].�_n ion ;,_z t l.. -.l �< a�.r r: Banlc
1? 3a B
t r —Azoze.
s'f A`, ,a e1.
ZI n
4..� 1.4-99201
City,
-�$e'.•
Stale
Phone ,—
(. 9) 557 r71
Contact Person
Joe ''bner
Phone if different than above
( )
Additional information
P _x'33
720 Th_i-;iv
S'leP
-
V 4g
u L C &1984 11
VE
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
DEPARTMENT APPROVALS
This is nota Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
❑ Commercial;
❑ New Construction;
❑ Additional structure;
❑ Residential
❑ Bldg alteration/addition
I Release
Release w/cond 1
Hold 2
APPLICATION #
Conditions/Comments.
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
N. 721 Jefferson ❑ Setbacks; El lot w/d; ❑ lot size; 0 use/zone;
O CU, variance, zone change; shoreline; 0 fence;
O Other
Conditions/Comments.
Engineers:
N. 811 Jefferson
Conditions /Comments
O Commercial; f< esidential; 0 Flood Plain;
O drainage V new access/approach; 0 fence;
O road improvements^ �� ^ ��� c_____,,,,,,,,,,V
2 I
Utilities:
N. 811 Jefferson
Conditions/Comments
Other:
Plan Exam
Fire Prev.
Conditions /Comments
Project Representative
Agencies Performing Special Inspection:
1
Telephone
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
G 64.97/- Gw.
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