Loading...
1986, 11-21 Permit App: 00014313 Residence(THIS IS NOTA PERMIT) BUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND COMPLETE IN INK (Please return this original and your building plans to the Department of Building and Safety) t Jr 1rtL/LLJ r%r1L'1J r%r1L 1 Llfl IJLr/'1rl I IVILI' IPL VJC Project Number A/31? Owner's Name LAST FIRST MI (jisS/ Project Address (Street Name & Number) / n Zip sot Of 32 -it 1, 014 I PPL r </q/1-f_z_, Applicant G7L j! Zit./ , /.i'r7E y yrf Address City r State Zip Phone ( ) Business Phone ( ) Contractor/Agent Lai '-1: - """S>oL ( Liel SS C_ Add ess '1E E l2scr_ciksco City .'15t) State (,6 Of Zip 9)?� Phone ) C/61...,- 1.0 Contact License Number (Required) 4/ L,M AP 3ei13�a3 Business Phone ( ) Architect/ Engineer Address City State I Zip I Phone ( ) Contact Business Phone ( ) Lender Address City State Zip Phone Describe Work laa 1 CC---LiC u.) i 04te_Aace Res. ty Comm. Subdivision/Plat Name Short Plat Number r O 1 Lo )48 Ltri-1 Assessor Parcel Number 3351/i — 2P01 Lot / I Block Plat Number ;Pertinent file Numbers Zone SFr' Comp. Plan Census Tract Number of Dwelling Units Number of Buildings Lot Size (Sq. Ft./Acre) Depth Frontage .Front Setback Left Setback 2.0 Right Setback tback 3 Rear Setback R/W Width Additional Information SAuE As Vett (iE ( MEST BUILDING INFORMATION Square Footage a /00CY r- 1009 LiFe 54-2- (• M: Number of Bedrooms 8ulldingTechnic Date lI Group Type 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 Legal Description Additional Information: Landscaping Drainage Plan Hydrants Topography Lighting Signage Shotoiines Highwater Mark chmeets: 1111111111111 IMIIIIMO I Si INMINIII MIII16111111 III IMIIIIIII II S" v D Ill • irk MIS MIS • IlL II IIIIIIIIIIII MIIIIIIIIME1111 nit II 1 Ill I 11 III• ii Fi US 04 III I. III . , iii .., . ....... r an am Ea wrAri _3: - 117 imo a IIRUn , i blek al IS 111 • In un, Ell "ENV laW 7nUME ._ , - , - . - ow . - -4 LOT MIQJLbM 111 , LOCK 4 ,TH 1 N . - r f- i. - - -- -FI -H LAN L-C-4-11)0q6oiss - - • ; *0 CLA5/S-1 DEPARTMENTAL REVIEW I certify that I have examined this application and state that the information contained in it and submitted by me or my agent to co ' a ile said application is true and correct. Signature Date Approved Cond. Approval Hold Environmental Health Application # W. 1101 College Room 200 Planning/Zoning N. 721 Jefferson Engineers 811 Jefferson Z'' ` / ZO 6' if? �� ,7,//N. Utilities N. 811 Jefferson ' i I I el/3L/Z' ver- ceJ, //Plan Review/Fire Prevention N. 811 Jefferson„ /6-36-8tf, - 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 agent to co ' a ile said application is true and correct. Signature Date 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 I State Zip Phone Business Phone Contractor Address City I State Zip Phone Contact License # Business Phone Describe Work Bar Sink(s): Drinking Fountain(s): Floor Drain(s): / Washing Machine(s): I Dsh Wshr(s): i Garb Disp(s): I Kit Sink(s): Lndry Tray(s): 1 Sew Eject(s): Urinal(s): WtrCloset(s): l% c� Lav(s): it !� Shower(s): /7 Tub(s): 2_ Bidet(s): � Other: Type; Waste/Grease Interceptor(s): i Sewer Y N Septic/Health No.: t Electric Water Heater(s): . / 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: (0115 4- : 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 DATE APPLICATION J MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 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 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/ Heat Pumps (BTU) 1-100M 101-500M 501-1,000M 1,001-1750M Over 1750M Compressor 0-3HP 3-15 H P 15-30H P 30-50H P 50 + HP Gas Piping 1-5 Outlets 1 6+ Outlets Gas Fired Heating System 1-100,000BTU 1 10,,;,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