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1986, 09-28 Permit App: 00013323 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 arfd4your building plans to the Department of Building and Safety) Jnnvcu nncPrQ MnL rvn L/Crnnn 4 Iv' C•Y I HI- JOC Owner's Name LAST FIRST MI r' 490 /D- ---,..J. P _ .e", Applicant Address City State Zip Phone ( ) Business Phone Contractor/Agent Adddess c5i [7n /4/ - a, d w -2 -ie s Phone ( ) 9i.6 097: ^'cense Number (Required) 3 — 9 — g7 Address bits State Contact Business Phone ( i Address •O• O.< 2 • • r c - ,h <.��'" � Ras *_ y ''c. p. Mar,� ;Blori" " - ckfi ;,a"�• lot + ' Number * ay. Yt' st `4rfi ';Zone Yr, Comp Pian s j y .+~'-' 5u ..'i RI.,,' .•n y NYm`bero(Bylldingstya- v4' rf q.. Is Lot Size (Sq. Ft./Acre) 3'. .� Depib i� / .f a.1 '1?.r > T I rL Y it p.. ,.. z. # d ".,fila k Frontage fT C )a e '" 'T Letr 33 y 3 y sa Right ,(back� �riet • RIW Width '4, ,:..... !r•jfi�-)F> `_n: t ',.'r''ze, 's4 <,`"°' 6 5i '"y, ",tom is Q —7 h j L - 1 .1 1 I. # I l` a" F� 'x ..S' 4-. ga '�"• '•. fi "S34,e4Faotage , ts` ri �'a L r4 L,\^ p,,Fq:, u P I ✓"• OO • d, ill d" ,w .�j vM ✓' } i i s' ', YI °.'" .f ;r rx� t' a'r- 2- ["Yu�.y ; -4 A'' #iti "'� • .t rr���ay�� ���� S k Yl: )F �,�Yi'', Tr-G`�`L.n :45W104) 10)NP I,NE09M _ +* ' �QJ• 4r s....:..• . y, 'Z 'l `� ,dot i..r 1.`'y ....NYe"S t. Y ++,,.6. „wY '-.3 ? - 'A.- .n „y r 'SXy .ir _; ✓L �`"'` yq � l : ..iu #.a's.:2. S '"✓5 �•} akyr 4 i^. E t `� tw •4 s. ezaft a .,{* }'r. it urni;er; i Bedrooms ","+I:- -4'*TT•1` #P .Dae . ".: . . ., ,y., ice" z _. +c Type ' i I I tI '=4.. Show on Site Plan: Additional Information: Lot Dimensions Existing Landscaping ! ' i T H- Structures Proposed Improvements Drainage Pian Hydrants 1 ; StructureSetbacks Topography { i Easements Septic System (s) Lighting Signage 7-- , — Water Lines Sewer Lines Shorelines Highwater Mark Fences, Wells Driveway(s) Right Way of Width(s) Names of _L_ Fronting Street Flanking Street —} I— t- Legal Description t__� l i wad441 .),:...na• - T_ Ml+:q:Jnab•I 1°,1.1 •ta 3:0QAt?ta:i,y 1.1•41AL:14 ...�rti t t .Mi . .. , a I T-� 1 ‘• .T Scale: • —I— —41 a- I F i 1 fi Date: 1_ Revisions: Attachments: 1 1 -.�- I r ti i - t LI t i Wo' NA/ Le1,7 /0* CL.Lz r b 24 T¢ T )p / r u.u`74 Zit.Y / 7 iopit--fr.e� 3: 7 r Wo' NA/ Le1,7 /0* CL.Lz DEPARTMENTAL REVIEW 1 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. Signature Date Cond. Approvalp Hold Environmental Health Application 0 W. 1101 College Room 200 Planning/Zoning N. 721 Jefferson N. 811 Q San N. 811eeJeff ferson LT _ Utilities N. 811 Jefferson Plan Review/Fire Prevention N. 811 Jefferson Other (SEPA/Critical Materlai/etc.) Fast Track/Special Inspection Information Project Representative Phone Address 1 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. Signature Date 1 • PLUMBING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 i Project # Owner's Name Last First MI 1` L oL) 1" Project Address (Street Name & Number) City State Subdivision/Plat Name Assessors Parcel It 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): 1 Dsh Wshr(s): 1 Garb Disp(s): Kit Sink(s): ` Lndry Tray(s): Sew Eject(s): Urinal(s): WtrCloset (s): Lav(s): Shower(s): 1 Tub(s): 1., Bidet(s): Other: Type; i Waste/Grease Interceptor(s): ; Sewer Y N Septic/Health No.: I I Electric Water Heater(s): I Drains -Roof: i 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 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 1 Miscellaneous 16, Dryer Range Gas Log Gas Water Htr. Solid Fuel/Wood Stove F/19 INis a- I 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 3-15HP 15-3OHP 30-50HP 50+HP Gas Piping 1-5 Outlets 6+ Outlets Gas Fired Heating System 1-100,000BTU 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