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1986, 11-07 Permit App: 00014059 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) SHADED AHEAS AHt I -UH UtI'AH I MtN 1 AL Uat project Numbers�. Owner's Name LAST FIRSTsMI —rt ,e'8�- ?nett 4 Project ddress (Street Name 8 Number) Zip Sarum 4011 CtkwRunn Ia QQzob Applicant `t, Li- b4enw Address 37OV 1V !4Dt rc&2 City 0775 are /)i State 141, Zip ei9o27 Phone ( ) ZZ$ /307 Business Phone ( 1 Sn Contractor/Agent SKY r �i 5:04-14,,e_ /14/14E-5 Add ess a/ J�� 37o V / r&C- City 27i Dieedlefrelif State l .a Zip 99at7 Phone 1 ) 2_262 /307 Contact • License Number (Required) 9(Y fit SW i 6 q i— Al Business Phone ! r ( ) Architect/Engineer Address City State Zip Phone ( Contact Business Phone l 1 Lender " - Address City State Zip Phone ( ) •m +,y aks+ »A«a =.; TMz w? w` s £ « as, -t-'. -•^'S `trx'4 .rte fx? .C'tx H{�yr =1 � Mr ' *" ."`-.' Comm '^u sem' ..'`• !Ili d.3�qsY Per"A�Cb + - 4 dy «„�-Fr tr^,a .z tea, itot asr. ., n 3 ;. Block ,e1.4c, Plat Number 7. `Li- art Y=�` w ;t r-. ” % . �' Y'•,+ fid-' aa, .°1V ta. xfi3+FR^ :?tro w'3" M Zone ' +1 u [ Comp Plan a' T .... ,Lrensus Trect"«. �r r'fir r ..i /sent; l •.- i`" ""` '{Jtimber f BuIIdl gse' - ,-. •' � ,`tot Size (Sq Ft /Acre' « Depth ✓ Frontage - f &_ ryry�a. ..#' a„ tX „pigtit Setback may, axu{'= . A+.Aearselha.r.k t .k:,q '.. h a Y Y RlW Widjh+.,;.,j ss*' Y i F• .6$ 1'w +u ry 5 ie° : r L 1 8.w;iA +C Y+=tAV"wv Id err. «yr# ii` '4{' r' a4+r,t� ` . `5 r a S �. �t.-w+^'t'<n a +w t,..,_41' I•f, 'iY✓.,w 4aF�-Y'* t�%'fr 1t3 k f a"� t:Lak n,, BUILDINOINFORMATION'-;,,'.°',.0 Squ a tae" ;. V '1 9 3rY '^. + .<.f d v n ,4{ akin �' M YI nD a* .. ni—/I(-/,^� / . / !" v LI ♦iii�y{y .M,}$%,{r '•'� 2' � 9 i ,�r. `ri' t },`.a � yry'Ey' ^ ti ✓LtYFr3h t 5 r „ tit d - - a 1 k y 4 • 9 " ., r"e'',4 CAM, 11 rLi`I,• F • ✓i +§ti%`'u t-%�tsa,� �.r t ... .a. :y "k3� .. w`"� t } "� a k r v� i r .P 'wY"I�.0 .k aY+r W'�.b!-*di" . '• • d \.4 .rM�Iefi! YS 1 d5 i$f� SnryT.�S Favi ai: �. • « Mr'r �e� '!t "yt ". M! 9b N ... • s •... 'L3iCr.#i"+ t�antber of Bedroom "4 er __ ...... M n .. 'y.y ✓1.t �..{b A"q '.S �i `"r,+ Group '`s .. Type ,h C Date. S 4 va . .. I�/ Environmental Health LLL11J W. 1101 College • Room 200 DEPARTMENTAL REVIEW \_ Approved Cond. Approval Hold Application N 8G - /2_4 I Planning/Zoning , 0 N. 721 Jefferson Engineers �� �/ea 403 p3 N. 811 Jefferson b� Utilities 0 N. 811 Jefferson L Pian Review/Fire Prevention ❑ N. 811 Jefferson Other (SEPA/Criticai Material/etc.) Fut Track/Special Inspection Information Project Representative Phone Address I certify that 1 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 NA /8 •• I T r L A 14 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 E. 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 I Zip Phone Contact License # Business Phone Describe Work Bar Sink(s): Drinking Fountaln(s): Floor Drain (s): Washing Machine(s): 1 Qsh Wshr(s): ` Garb Disp(s): Kit Sink(s): l Lndry Tray(s): Sew EJect(s): Urinal(s): Wtr Closet (s): 1,1 Lav(s): 3 Shower(s):\ Tub(s):1 Bidet(s): Other: Type; Waste/Grease Interceptor(s): Sewer Y N Septic/HealthNo.: Electric Water Heater(s): 1 1 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 q" V C MTM 'D -3 0,q . sD!L3S Novy AfrIztatil