1987, 03-11 Permit App: 87000579 Poolu
C
01
7
U
IN
- (THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
DEPARTMENTAL REVIEW PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
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.
Signature Date
(Please return this original and your building plans to the Department of Building and Safety)
Approved
Cond.
Approval
Hold
Environmental Health Application ff
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson ---
Engineers
N. 811 Jefferson --- ---
Utilities
N. 811 Jefferson —
Pian Review/ Fire Prevention
N. 811 Jefferson ---
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.
Signature Date
(Please return this original and your building plans to the Department of Building and Safety)
ttt Vt iitV UVII.
Lot Dimensions
Landscaping
Existing Structures
Drainage Pian
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