1987, 01-27 Permit App: 87000219 Residence (THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF HE FORM YOU UNDERSTAND
COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
SHADED AREAS ARE FOR DEPARTMENTAL USE n r
I Project Number G.
Owner's Name T FIRST
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Project Address(Street Na e 8 Nu r) Zip
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Applicant Address
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City State Zip
Phone
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Business Phone
Contractor/Agent Address ,/ /,
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ContacT License Number(Required) Business Phone
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Architecyf ngineer Address
City State Zip Phone
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Contact Business Phone
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1^ Lender Address
City State Zip Phone
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�lNt� Res. / Comm.
r Subdwisfon/Plat Name/ t Plat Number
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. Assessor Parcel Number Lot Block Plat Number
2/5 — 27055 I
Pertinent Fir,;Vu Zone Comp.Plan Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
I t35 74
Front Setback Left Setback Right Setback Rear Setback Rl W Widtf)
Additlonai information Square Footagez e8�f uFF3
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PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
IProject#
Owner's N Last /t First MI
Project Address &N f JS=r) g�
Ci State WSubdivision/PlatQ • Ii c S
Ass ors Parcel# Lot Block Plat#
Applicant Address
City State Zip Phone
Business Phone
Contractor Address
City
State Zip Phone
Contact License# Business Phone
Describe Work
Bar Sink(s): Drinking Fountain(s): Floor Drain(s): ' Washing Machine(s):
Dsh Wshr(s): Garb Disp(s): Kit Sink(s): Lndry Tray(s): Sew Eject(s): ,
Urinal(s): Wtr Closet(s): Lav(s): Shower(s): Tub(s): / Bidet(s):
W
Other: Type;
CC
XWaste/Grease Interceptor(s):
u_ 1.14""
Sewer
Sewer Y N Septic/Health No.:
O
CCI
CCI Electric Water Heater(s): Drains-Roof:
2
Z 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: (005+:
t3ASE T3OAl2Q If4E4T
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 APPLICATION
OWNER OR AGENT DATE
/ . .
ENERGY APPLICATION
APR 2 3 1986 141...e..42.‘:„
HOUSE TYPE : 952 Rancher
ADDRESS:
BUILDER: Nimalaya lanmca� Tnr
HOMEOWNER: Himalaya Homes, Inc.
•
FLOOR AREA: 1st 952'sq. ft. • 2nd
• BASEMENT: 884 s q. fr.. el `f-
WALL INSUL. : ...1? - . 9 AREA
Cantilever .
REGOK INSUL. R - ,29 AREA •
SLAB INSUL. • AREA - .
CEILING ' INSUL. R - 38AREA
VAULTED INSUL. AREA
WINDOWS. (Group Same Size Windows On One Line)1
BRAND MODEL U-VALUE HOW MANY SIZE AREA (SQ. FT.)
(Number of Windows x Sq. Ft.)
Milgard 2100 .41 2 5° x 4° 40
• 1 4° x 3° 19
2 5° x 3° 30 _
1 3° x 3° 9
Wells 420 .63 5° X 6a 33.S
Skylight Untested 4° x 2° 8 x 7
3 28"x76" 44.3
Fixed Glazing .4Q 2 18"x76"° 19
Optional fixe32 18"x22" 5.5
4' 211 11
TOTAL WINDOW AREA 217.6 (A)
•
SEE OTHER SIDE
SKYLIGHTS (LESS THAN 60% SLOPE)
BRAND MODEL U-VALUE HOW MANY? SIZE AREA (SO. FT.)
(Number of SKYLIGHTS Sq. Ft.)
X'_._. X 2 •..,.._.,_
• X X2 •
X X 2 ____
TOTAL SKYLIGHT AREA (8)
TOTAL GLAZING (ADO (A)+(B))2 (C)
DOORS (FROM HEATED SPACE TO UNHEATED SPACE)
•
BRAND MODEL U-VALUE HOW MANY SIZE AREA (SO. FT.)
(Number of DOORS Sq. Ft.) .
Thermatru 1 3°x68
**TOTAL DOOR AREA
•
VAPOR BARRIER
•
TYPE OF HEAT Electric Baseboard SIZE (BTU)
YOU CANNOT CHANGE THE TYPE, SIZE OR BRAND OF WINDOWS OR HEATING SYSTEM AFTER
APPROVAL WITHOUT RESUBMITTING TO THE DEPARTMENT FOR APPROVAL OF THE
MODIFICATIONS. •
INSULATION INSPECTION REQUIRED. •
AN INSULATION INSPECTION IS EQU R TER FRAMING, PRIOR TO' SHEET ROCK."
' OWNER/AGENT:
1 I lud sliding glass doors.
I. 2 G g area shall not exceed .17X of the total heated floor area.
•
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I I j • _ I - Contractor Himalaya Homes, Inc.
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! Legal Lot 5, B1151, Grafqs fddn.
I } - _ . e 10919 0th _Aven. . . .
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Scale:? 1" = '20`
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DEPARTMENTAL REVIEW
Approved Cond. Hold
pp Approval
Environmental Health Application#
k(7-—‘1 020
W. 1101 College
Room 200
Planning/Zoning
❑ N.721 Jefferson
1 Engineers
LJ N.811 Jefferson g7 FNS o,
Utilities
❑ N.811 Jefferson
Plan Review/Fire Prevention , /
❑ N.811 Jefferson
Other(SEPA/Critical Material/etc.)
0
❑ 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 i.