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1986, 11-19 Permit App: 00014422 Residence(THIS IS NOT Ac*RM-T) BUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OFITHE FORM YOU UNDERSTAND COMPLETE IN INK (Please return this original and your building plans to the Department of Building and Safety) SHADED AREAS ARE FOR DEPARTMENTAL USE Owner's Name FIRST 0S MI 82i CLL' lc?ro Applicant Address State Zip QQ20,6 Phone Business Phone Contractor/Agent14 Contact Address i1t-2g it l A v SPK4AJ€- Architect /Engineer Phone State Contact Lender Phone Business Phone ( ) Address Phone Frontage i4s Flight Setback RIW Widttt e„ o©tage. -13 Group Type v&) DEPARTMENTAL REVIEW I certify that I have examined this application and state that the information contained in it and submitted by me or my . gpht to compile said application is true and correct. Signature ' ted? L ec/�-�i:ti Date `//l ,U fo Approved Cond. Approval Hold Environmental Health Application M g / qo // -. <��19 Room1101 College Room 200 /Planning/Zoning44_, N. 721 Jefferson t ._ ife / / Engineers N. 811 Jeffers• ¢ C ' � �r-�--�►� _ _ �• �� // ' /Utilities �� , n N. 811 Jefferson �{lJi.j10 ilia2 (6.911!19 111(,ty/ ;{ Plan Review/Fire Prevention N. 811 Jefferson Other (SEPA/Critical Material/etc.) Fast Track/Special Inspection Information Project Representative Phone Address I certify that I have examined this application and state that the information contained in it and submitted by me or my . gpht to compile said application is true and correct. Signature ' ted? L ec/�-�i:ti Date `//l ,U fo , Show on Site Plan: Lot Dimensions Existing Structures Proposed improvements Structure Setbacks Easements Septic System (s) Water Lines Sewer Lines Fences, Wells Driveway(s) Right of Way Width(s) Names of Fronting Street Flanking Street Additional Information: Landscaping Drainage Plan Hydraiits Topography Lighting Signage Shorelines Highwater Mark • Legal Description ..• •••.'" •i- I „.1,t1.,ikt-Oig?ilif- • • I • ,t ", • ; • "IttitIt• t1t: 1 t ' ----I-, 1 1 : P. PEP - • P L A t 1 I 1 A -L T. -E-L E 1 1 ; • • • . --I- • , ---; : ; • E I ! I i I I T 11:114)i6' V :1'.:1:. , ' , . .,. ;"'iltifqiitiff**. ; ,. ' . • • ....'. ‘ ,' ' • Y ..{ .. ,'.. . i '. ' ' .• '41.h.tilt..4.0iiliW‘11 .,liti' hill V.4.44,A, t 1,i t I • I I -I,'" ; • t • • .; • ; t• ;'-'1 ; ; • • I 0 • ; 1 • • - - -:::;:. • -."•. • ) ...., . ' • " '• • '-': .....1: ''...I:"...1"....•.. t's • ...: 't :1:1', . .::•::":4:-.-:•,..•.;:.......t.:.-..-:.: : t• .;:...„:::::::-.•..::,:::::,:: ; E:E:'::' , • „ ..,... ....„ • „.... ,,....... ...,,..... ,...........•,,,,,•.•._ ., .......,,,,,,....— . • . ....•.•.........•..... '.'.'.I.•,...,,,... . . . . . . , , , ., . , ..,..,•., ..,,,, ... .::tIt':::,:-• , - • •-•• • T "1" • 1 • t • 1 • i; 001 --I • 404211 46:Ls • • 144.4-1- 1-1,44.4 E` 4-- \ • "-•-• I Jh \ \ ‘j+—\; \ \ \ \ \ rs \ 5. ;• 1 4.1-4 14. 1 IC I. - • I 1 • j -t- ;4; ; I t • ; 1 . .1 1 • ; ; ,... T • 0" o 712,4,7e17.."(4 1 • . i•• ea tr • 1 • -; • t - • , • • , 't • - • 1 t I • , — fit •-• -. • Co .•,' PLUMBING PERMIT APPLICATION #F THIO ORMH YOU UNDERSTAND PLEASE PRINT AND COMPLETE ONLY THOSE Owner's Name Project Address (Street Name & Number) City Last i State Assessors Parcel # Applicant City State 1 Zip Contractor City Project # First MI Subdivision/Plat Name Lot 1 Block IState I Zip Contact 1 License # NUMBER OF FIXTURES Describe Work Address Phone Business Phone IAddress Phone Business Phone I Plat # Bar Sink(s): Drinking Fountain(s): I Floor Drain(s): I Washing Machine(s): I Dsh Wshr(s): Urinal (s): 1 IGarb DIsp(s): Kit Sink(s): IWtrCloset (s): 1 Lav(s): Other: Type; 1 ILndry Tray(s): 1 Sew Eject(s): IShower(s): / 1 Tub(s): IBidet(s): Waste/Grease Interceptor(s): Sewer Y N Septic/ Health No.: Electric Water Heater(s): 1 1 Drains -Roof: 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: I(Or)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 OWNER OR AGENT APPLICATION 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 0-10,000 CFM Air Handling Units 10,000+ CFM Refrigeration Systems/ Heat Pumps (BTU) 1-100M 101-500M 501-1,000M 1,001-1750M Over 1750M Compressor 0-3HP 3-15HP 15-30HP 30-50HP 50+ HP 1-5 Outlets Gas Piping 8+ Outlets Gas Fired Heating System 1-100,000BTU 10v,:.00 + BTU „St 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. 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