1986, 06-13 Permit App: 00011575 PoolFE]
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DEPARTMENTAL REVIEW
I certify that I have exam this appli tlqnK/and state that the information contained in it and submitted
71 11 /1
bymeormyagenttocom !�Isaldappllcat h Is true and correct.
Signature
/7
(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)
ApprovedCond.
Approval
Hold
Environmental Health Application #
W. 1101 College
Room 200 1A--11
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson 1--7
Utilities
N. 811 Jefferson L-7�7
Plan Review/ Fire Prevention
N. 811 Jefferson
Ot her (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
I certify that I have exam this appli tlqnK/and state that the information contained in it and submitted
71 11 /1
bymeormyagenttocom !�Isaldappllcat h Is true and correct.
Signature
/7
(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)
Show on Site Plan:
Additional information:
Lot Dimensions
Landscaping
Existing Structures
Drainage Plan
Proposed Improvements
Hydrants
Structure Setbacks
Topography
Easements
Lighting
Septic System (s)
Signage
Water lines
Shorelines
Sewer'Lines
Highwater Mark
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Scale: _ d
Date:�;�
Revisions: Attachments:
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