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"