1984, 06-11 Permit App: 00000630 Pool BUILDING 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 ke /^� (last)) (first)fi (m) Department Use Only
1'r��.-YT' a-H-rf-r��L.L.5 i Res. Comm
2 Project Address(not Mailing Address)ar Road Name Space Zip fQ 2� Sig
LS 18 £, S'i-R-P g-Pog, LA-, c q 214 (�/
3 City/Comm�p4jy State Subdivision Lin�� �I II'
Y�t t� 11.E �t.), ' ijc.
4 Assessor Parcel No. Lot ( Block zi____ l'
I 441-5-4
j�� 2- — 3 co.x---
7.. - * * * DEPARTMENT USE ONLY * * *
5 Sic Code Zone Act.# ZoneProject No. _
-5c,z e)
6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage r
l 1 tomS4
7 Set Back-Front I(L)S-1 (R)S-2 l Rear Census Tract I 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
C iR Po-61_3 / `I l mo. / 141,
1 r
Zip CityState Phone
çerso
uv1} (Sa`? ) 927-3' 7License No. Phone If different than above
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(YIN) 'SEPA Exempt(Y/N) Date
Ye
15 Type Work ❑ Bldg 0 MH ,i0I, New ❑ Replace X.Other
0 Fire 0 Demo 0 Add/Alter ❑ Move
14 Describe Work
C E STaacT- Acv 3.ffr
1 pplicant Nes., Street Address
11 Zip CitygejleyttA.4.52_ 64_4
le2Qt(3
* *
Lender Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information
-amu) Poe)i- f f X 3 f 6LiA-c-
1111 Fir /' _ - c C 1-1.
1z54C:5 ¢4Z(6. 3722
DEPARTMENT APPROVALS
This is nota Permit
Application Type
(Standard unless (Indicated approvals required in either"release"or"release with conditions"
otherwise indicated) space prior to permit issuance.)
❑ Fast Track
❑ Early Start Release
Release w/cond 1 Hold 2
❑ Environmental Health ❑ Commercial; ❑ Residential ', fl
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition $
Room 200 ❑ Additional structure; ;
APPLICATION#
Conditions/Comments:
❑ Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; 0 Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone;
❑ CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments:
❑ Engineers: ❑ Commercial; ❑ Residential; 0 Flood Plain;
N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
❑ Utilities:
N.811 Jefferson
Conditions/Comments:
El
Other:
❑ Plan Exam
Fire Prey.
Conditions/Comments:
c
c_J
c° Project Representative Telephone
«a Agencies Performing Special Inspection:
O c 1.
U =
N c
F`- E 2.
O
lb c
LL
3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
• -•.411.1CM.1........6.••••••Will••••••• •.......................-••••• - •
• •' , .,
( .I
2 :
• •
-• ',, •
. ,
.. ,..,,,
,,;7'''' . •
•/,,' . '
. .
. '
•
• •
* •
. .
, -
. .
1 '
* •
•
2-3-27-i-7- V .- .
• .
• '
.
1 . . 7 ---.--------L.-I-4L-A47.7-Z_.p_
,.....,
•
I t •
L____ - 1_ t______-___ _____ _ _
. -
'N.
4 , .
, . .
4r. /y, i . 1
. I 1
. .
\-
1 _ AK-4
I . I - . . -
/
/5-
. I 1 . . ' • ;
- -.\ i : . ,
„ i r'
oti ka tr- -
I \ / P i‘fl .;
oi i 4.
;
\ ,$) ,/ VI 1 . - i Y
, ty- 9., • _
, 4 '4 . \2:--171. n
/ ; -N, I
•I i - 1 SN '
. , .4.• i I I . t :• .
/ , I • • 1
Lo• i 1 f____L_i-4 I. • • I I .
k_ALL
a _Ih
. i
• it, • •1 N:- :
_-,-• N--:.-5- 0-4.4- .
----f- ' 1., -\.7..---f_+.k._ _-4.--?-i-----s-L..g .._____ JI )-- :5_,-r. .. . 1 IA) . •
\ -\
--------41.
11 V\\\N
• 0— '- 1.2-
,
. -. ‘, ti — -x-iz.,c ... -•
1 , i • . ..- _. _ . '- ---- \ \ . ..
i - -
1 \ 1 \ s
\:, —1-7-'s_s- s , . • . F -
. ,
----t! 4A,S\- . .‹,,..\\ , t .! _ •.-/ --
1 • i - -a - i \ ‘ , \ . ,,, ---\ • - y . . I_
• i •<-.:-..••• ••- '-'• •
i . s i \ , • .
. ,
, 6- I ------77.----1-. . ..`-:-------4 , l• - ti-C.E2.-_;6 -
. _T=r_ .1'..' i . . -
. 4.3 r d' I . •
i ‘i .
1
_j 1 w i •
- .
f t. I i
, .
-rf
I 03 1 >
I ,1 I
. CI .
- :. --1---4 4.•:-:.--.' 1 I ' 1 - V . •
. ' --- ---------i----__
. i
* . .
'
,--7---------------- l't
• - ""-`•-- .-2 1...,-, . 7------ •
------- - --------- ,;L:L-2FEL.P. I.
.
1 - •