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1984, 09-20 Permit App: 00002383 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 Own amm�ee last) ,,� /7 (first) (m) IpepartmentrfeOniy PT€C--� ij/ C__ �"!/��� . Fps. Comm 2 Pro ect Address (not Mailing Address or Road Name Space Zip T -4--J 1/1,on �c/ q946 )-j V 2i�/2 3 City/Community �j ee) GC State Subdivision/ Plat Name K Y aI LSU ' 4 Assessor Parcel No. Y 5- / , / — O Li © / Lot / Block L/ * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act. # Zone Project No. 6 Dwell # No. of Buildings / Sq. Ft./Acre Depth Frontage 7 Set Ba r 1 (L)S� 1V I(R)S -2 I it I Rear Osnsus Tract I Module No. Initials (/� 16 Architect Firm Name Street Address Zip City State Phone ( ) Contact Person Phone If different than above ( ) Contracto Firm Name /9-3 CO �,�i�L Street Address L yS Su Zip City 9 g c, 3 S,Aoec- State Oa . Phone ( ) YYS - 'o>.a. Contact Person Roeg m ,�. _ License No. AV Phone if different than above CPA�c .) ( ) cis -0-950 / �,iscro 8 Owner/Agent (if different than #1 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check (Y/N) Other (Y/N) SEPA Exempt (YIN) Date 15 Type Work Bldg di Fire E MH 0 Demo k- New ❑ Add/Alter ❑ Replace ❑ Move ❑ Other 14 Describe Wo / VI C 4 c= F r4.– `i inL� / ra'vr e z . 10 Applicant Name Street Address 11 Zip City State Phone ( ) Lender Street AddressZ– p5-7e-706-ez-ed (it Gil4 L� C. Zip State Phone Contact PersonerA4 /// (ei-G—Z-i..–E /// - gh td�G • Phone if different than above ( ) Additional Information 14113 E' 4-Y- Ci ftp i 354-. Go DEPARTMENT APPROVALS 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold Application This is not a Permit ❑ Type (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 id/ Environmental Health ❑ Commercial; ❑ Residential W. 1101 College ❑ New Construction; ❑ Bldg alteration/addition Room 200 ❑ Additional structure;( 30(, 7 APPLICATION #D l — / D l �f � ' �' Conditions/Comments• ❑ Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; 0 Frontage; N. 721 Jefferson 0 Setbacks; ❑ lot w/d; 0 lot size; 0 use/zone; 0 CU, variance, zone change; shoreline; 0 fence; ❑ Other Conditions/Comments. - a Engineers: 0 Commercial; 0 Residential; 0 Flood Plain; N. 811 Jefferson 0 drainage 0 new access/approach; 0 fence; .,/ . I O road improvements Conditions/Comments. /.!"4//4 ‘_t -04 Id Utilities: N. 811 Jefferson Conditions/Comments • ❑ Other: • • Plan Exam Fire Prev. Conditions/Comments• Project Representative Telephone Agencies Performing Special Inspection: 1 Informati 2 3 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold / Lo P tiAk J " Pre_ ASTM D-303? SD/, 35— Q 2% 444 Avg` 6 PP1/2 (biro/? g/ 0 W 1- H X u- O W m 2 D Z PLUMBING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 Owner's Name (Last)/�(First) (M) no sC© Department Use Only Project No. 2 Project Address (Not Mailing Address) Space a Zip `/.- c 02 dit44elt i 3 City/Community I State Subdivision/Plat Name 4 Assessor Parcel No. I Lot Block 23P� 16 Contractor Firm Name pc0 6 _ ,lettuce e -4c -t—c__ Street Address /3-2io3 a tleiset•G 17 Zip g907(J,42.te City e_.- State - Phone ( ) fit -.3,f4.23 18 CefAufarsonCo I De$'o— 1 License No. am cd2 OG.'( Phone if different than above 8 Owner/Agent (If different than #1 above) ' Business Address ' 9 Zip City I State Phone , ( ) 15 Describe Work: New ❑ ; Addition/Alteration ❑ ; Replace/Repair ❑ 7 Total Number of Fixtures: 10 Applicant Name Street Address 11 Zip City State Phone ( ) 9 BarSink(s): Drinking Fountain(s): Floor Drain(s): / 1 Washing Machine(s): / 10 Doh Wshr(s): Garb Diap(s): Kit Sink(s): / Lndry Tray(s): / Sew Eject(s): 11 Urinal(s): Wtr Closet (s): Lav(s): I Shower(s): / I Tub(s): / Bidet(s): Other: Type; 12 Waste/Grease Interceptor(s): 13 Sewer Y N Septic/Health No.: 14 Electric Water Heater(s): / Drains -Roof: 15 REPAIR OR ALTERATION: Drainage, Vent, Water Piping/Treatment: Y N 16 Lawn Sprinkler System(s), Including backflow device on any one meter: 17 Vacuum breakers or backflow devices in excess of line 16: 1-5: (00 5+: 1304e 0'2- 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 a `79DATE [ " X " *