1986, 08-22 Permit App: 00012951 Duplex (THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE I• N INK
(Please return this original and your building plans to the Department of Building and Safety)
SHADED AREAS ARE FOR DEPARTMENTAL USE n
Owner's Name LAST FIRST MI
6,2 ,,/3,6.
Project Address(Street Name&Number) Zip
56.4_61
Applicant �_ Address
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City State Zip Phone
C12-0 6
Business Phone
( )
Contractor/Agent Address
�2 y F. ( 2z I z___ S f O Cts
City _.(-
:.7.7") State Zip Phone �l
Contact License Number(Required) Business Phone
(sei --M YT 24( 6`1\I ( )
Architect/Engineer Address
City State Zip Phone
( )
Contact Business Phone
( )
Lender Address
City State ( Zip Phone
( )
Des-c'$1e Work 4. fi ,`. - % a cs" 4+ .:,COIO :-..-a- ..:
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dontPiat,�laroe/Short Plat Number, ''r . .,,,-,
`4,7
Assessor Parcel Number < ; .. -,
.� �^_ , �° ;4,.';f, plos�c Plaf Number `
Pertinent File Numbers Zone comp_plan Census Tract
,mss
Number of Dwelling Units Number of Bull, .v= Lot Size(Sq.Ft IAcre). - Depth .: Frontage
2 ,..# - c °; tom: k
Front Setback Left Setback Right Setback ,Rear SetbacI ` Rt W Width
Additional Information
(Square Footage
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i>d Nun*er of Bedrooms
Building Technician Date Group Type
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DEPARTMENTAL REVIEW
Approved CHold
/ Approval
Environmental Health Application M _.4 -� �1 9f',/,‘ �
W.1101 College a
Room 200 ler
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Planning/Zoning
❑ N.721 Jefferson
Engineers
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N.811 Jefferson !>`
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Utilities I
❑ N.811 Jefferson
Plan Review/Fire Prevention ir"a;" (:'
❑ N.811 Jefferson /u G)
Other(SEPA/Critical Material/etc.)
❑ Fast Track/Special Inspection Information
Project Representative Phone
Address
I certify that I have ex- fined this application and state that the information contained in it and submitted
by me or my agent t. • pile said application is true and correct.
Signa • L.�� �fi/ Date 7
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PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
IProject
Owner's Name Last First MI
Project Address(Street Name&Number)
City State Subdivision/Plat Name
Assessors Parcel# Lot Block Plat#
Applicant Address
City State Zip Phone
Business Phone
Contractor Address
City State Zip Phone
Contact License# Business Phone
Describe Work
Bar Sink(s): Drinking Fountain(s): Floor Drain(s): Washing Machine(s):
Dsh Wshr(s): 2_ Garb Disp(s): Kit Sink(s): Lndry Tray(s): Sew Eject(ay
Urinal(s): VVtr Closet(s): Lav(s): L Shower(s): Tub(s): Z.--' Bidet(s):
N Other: Type;
CC
I- Waste/Grease Interceptor(s):
LL Sewer Y N Septic/Health No.:
O
CC
LI Electric Water Heater(s): Drains-Roof:
Z REPAIR OR ALTERATION: Drainage,Vent,Water Piping/Treatment: Y N
Lawn Sprinkler System(s),including backflow device on any one meter:
Vacuum breakers or backflow devices in excess of line 16:1-5: (00 5+:
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state of local laws regulating construction or the performance of
construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
•
Project#
Owner's Name Last First MI
Project Address(Street Name&Number)
City State Subdivision/Plat Name
Assessors Parcel# Lot Block Plat#
Applicant Address
City State Zip Phone
Business Phone
Contractor Address
City State Zip Phone
Contact License# Business Phone
Describe Work
Fans Evaporative Cooler Hoods Electric Furnace/Ducts Miscellaneous
Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove
Air Handling Units 0-10,000CFM 10,000+CFM
Refrigeration Systems/ 1-100M 101-500M 501-1,000M
Heat Pumps(BTU)
1,001-1750M Over 1750M
Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+HP
1-5 Outlets 6+Outlets
Gas Piping
Gas Fired Heating System 1-100,000BTU tOv, 00+BTU
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein-or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF APPLICATION
OWNER OR .DATE