Loading...
1986, 11-21 Permit App: 00014314 Residence(THIS IS NOT A 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) Project Number Owner's Name LAST FIRST MI UC.)LjQSs 4-ka- Project Address (Street Name & Number) Zip Sou -rt -t 3241 (L i, PPLO- Or- -ii2e6,, Applicant 9 /316 / I /10At 4 Address City State Zip Phone ( ) Business Phone ( ) Contractor/Agent -V.R.,‘Pfkkr06u45s 3-,c(1, eJ Address 8/ Jaz City (/ jf��92 Statea� Zip Phone Contact grketey �4 s License Number (Required) *Q-1-41 kND k Business Phone ) Architect! Engineer Auuress City State Zip Phone 1 1 Contact Business Phone ( ) Lender Address City State I Zip Phone ( Describe Work Si 17)E-k)e— Le) (014-1Vr�',,& Res. Comm. Subdivision/Plat Na e/Short Plat Number i0 ttin AU� 4111 Assessor Parcel Number �Q 3364/-2&,q Lot Block 1 Plat Number Pertinent File Numbers Zone r-""1? Comp. Plan Census Tract Number of Dwelling Units / 1 Number of Buildings Lot Size (Sq. Ft./Acre) Depth Frontage Front Setback 3o Left Setbac�3 Right Setba 22 Rear Setback R/W h Wi t Additional Information SE; ,1,-s C— L1 -U41- 0Letic —JT" Square Footage 'tog ot-rp-' IC)OCI tiR3 • o P 542_ GAe 2 cr 0 LL Z_ 0 Z_ 3 -J 5 in Number of Bedrooms .BuildingTechnician Date Group 2-3 Type urJ Show on Site Pian: Lot Dimensions Existing Structures Proposed Improvements Structure Setbacks Easements Septic'System (s) Water Lines Sewer Lines Fences, Wells Driveway(s) Right of Way Widths) Names of Fronting Street Flanking Street Landscaping Drainage Plan Hydrants Topography Lighting Signage Shorelines Highwater Mark =rep am ma L7n?3hiii 7 it ?3: � iii ?;�i.; ., ?31i�;;:? diil � � ---l- / - -l-'`-- / -- - - -~ -- -^ | 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 compile said application is true and correct. Signatu Date Yc Approved Cond. Approval Hold Environmental Health Application M W. 1101 College Room 200 Planning/Zoning N. 721 Jefferson Engineers.11f ;1‘'_ �4;, 6/r N. 811 Jefferson // ..71 ,' � Utilities N. 811 Jefferson r{{. a4/iG 5,a) r` fir / Plan Review/ Flre Prevention N. 811 Jefferson i� k&T 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 compile said application is true and correct. Signatu Date Yc rn w 1- CCH X ctw O w m i 2 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 l State Zip Phone Contact License # Business Phone Describe Work BarSink(s): Drinking Fountain(s): Floor Drain(s): Washing Machine(s): / Dah Wshr(s): ' Garb Disp(s): 11 Kit Sink(s): / Lndry Tray(s): Sew Eject (s): Urinal(s): Wtr Closet (s): /7 ,L_ Lav(s): � Shower(s): � 1 Tub(s): I7 4� Bidet (s): Other: Type; Waste/Grease Interceptor(s): Sewer Y N Septic/Health No.: Electric Water Heater(s): J / 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: (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 DATE APPLICATION MECHANICAL PERMITAPPLICATION 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 0-10,000 CFM 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 Gas Piping 1-5 Outlets 1 6+ Outlets Gas Fired Heating System 1-100,000BTU / 10v,�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