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1986, 04-23 Permit App: 00010663 Pole Bldg • BUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT ANDCOMPLETE 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 7472* (last) (first) (m) r Department Use Only r_` J f FSS. Comm 2 Project Address(not Mailing Address or Road Name Space Zip 3 Cit /Commun,'1ty -1 " State Subdivision/Plat Na e ,,,,, ,.,....)„, _..,,,,, ,tz......4_, 4 Ar Parcel No. LotBlockv. f 4 5-44 --- 3` 1 I * * * DEPARTMENT USE ONLY * * * 5 Sic Code Zone Act.# Zone Project No. 6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage / Z _2470 • ,/, - 7 Set B�F.�t / I(L)S�4( (R)S-3, ( 1 Rear Census Tract Module No. r Initials NI � 1 * 16 Architect Firm Name Street Address * Zip City State Phone ( ) Contact Person Phone If different than above ( ) ContractorCN STEEL BUILDIN83. INC. Street Address G 11524 SPRAGUE AYE. spolu►NE TA 99206 Zip City State Phone ( 5° ) a�g _ c2-c,2 C CoRteOt Person License No. Phone if different than above 8 Owner/Age (if different than#1 above) Business Address 9 Zip City State Phone ( ) 12 Review Required Plan Check(Y/N) Other(Y/N) 1SEPA Exempt(Y/N) Date 15 Type Work ,rt.--Bldg 0 MH X New 0 Replace 0 Other 0 Fire ❑ Demo ❑ Add/Alter 0 Move 1 14 Describe Work n 4-/ _4_1 10 Applicant Name Street Address 11 Zip City State Phone ( ) * Lender Street Address * Zip City State Phone ( ) Contact Person Phone if different than above ( ) Additional Information 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.) 0 Fast Track Early Start Release Release w/cond 1 Hold 2 ❑ Environmental Health ❑ Commercial; ❑ ResidentialW. 2 � Rom College ❑ New Construction;alstructure; ❑ Bldg alteration/addition /� Room 200 ❑ Additional structure; � APPLICATION# 0) V /j 77 Conditions/Comments: Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage; N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; ❑ CU,variance,zone change;shoreline; ❑ fence; O Other Conditions/Comments: Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence; ❑ road improvements Conditions/Comments: O Utilities: N.811 Jefferson Conditions/Comments: Other: Plan Exam Fire Prey. Conditions/Comments: a c ❑ Project Representative Telephone NAgencies Performing Special Inspection: c 1. U -'- F`- E 2 7) o LL • c 3. 1 Indicate above or attach conditions relative to final as built approval 2 Indicate above or attach reasons for hold FINAL INSPECTION FOR SEWAGE SYSTEM AT _ (numerical address or Tot and block in plat or section, towns Please fill out in heavy dark line (felt-tip pen or equal) with is to include outline of structure (if l erty. Identify by measurement actual locationof septic tank, drat p r drywell, or other on-site sewage facilities, property lines closest t. on-site well (when applicable) , driveway, must be referenced to a known fixed surfacenstructured road �ntage. Septic to NORTH 1 A---- K-K m X --,C. Cyo 4r1.99° Kx 4b f140p'/ h4.*7e 1 G 9 [- ■ 1. O If t !4 /2 /2 J r"--------------- Li I I I I eat I I � t.s I I tv ,'IAs I I I i ! I SS SS ,s'� FINAL INSPECTION MADE BY (::::::::::;) 'lir 4001! COMMENTS: (I CTOR'S N' 1 ) - T (DATE) 1/83 f- . • A -. I ct.e.ic \ VI 'Zoo cef C. I(S- ocYL. zoo ' 36' lor 1 9-0 45 Z t‘fl 1) 14.owt a ZS' 601 A .• -0"