1986, 08-28 Permit App: 00012870 Swimming PoolShow 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:
Date:
Revisions:
Attach
011
X
MA
701
01
DEPARTMENTAL REVIEW
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
(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLYTHOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
etaAnr-n ADMAC AOC CnD MCOAO-r"CAITAI I 10
Cond.
Approedl Approval
Hold
Environmental Health Application #
W. 1101 College
Room 200
Project Address (Street Name & Number) Zip
Irbb. Z/ 77 L/IL
Applicant
Lv btS 7Z) M Pe -:t, -S- r_S'
Address Q ,
/// q�� , P1 A.Y-S GAO
City
Planning/Zoning
N. 721 Jefferson
Zip
Phone
Engineers
N. 811 Jefferson
Business Phone
(. ", ) y'�2 - s " 9
Contractor/Agent
/20 rJ SCJ LnJs
Utilities
N. 811 Jefferson
City
State
Zip
Plan Review/ Fire Prevention .
N. 811 Jefferson
Contact
S'� C -A -Js bj
License Number (Required)
n s; C9 ;� r J" '
Business Phone
(sad)�z 9
Architect/ Engineer
Other (SEPA/ Critical Material/etc.)
City
State
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
(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLYTHOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
etaAnr-n ADMAC AOC CnD MCOAO-r"CAITAI I 10
Project Number yl
Owner's Name LAST FIRST MI
Project Address (Street Name & Number) Zip
Irbb. Z/ 77 L/IL
Applicant
Lv btS 7Z) M Pe -:t, -S- r_S'
Address Q ,
/// q�� , P1 A.Y-S GAO
City
State / 1 Q
Zip
Phone
Business Phone
(. ", ) y'�2 - s " 9
Contractor/Agent
/20 rJ SCJ LnJs
Address
/// 9 /fid ,- -P/ AIf S
City
State
Zip
Phone
Contact
S'� C -A -Js bj
License Number (Required)
n s; C9 ;� r J" '
Business Phone
(sad)�z 9
Architect/ Engineer
Address
City
State
Zip
Phone
Contact
Business Phone
Lender
Address
City
State
Zip 7phone
( )
DescrfbeWorkRes.
/' Gt ! i� i[ l�U✓ Sc✓/�-1 rpt r �,�Lp- !"6t� �-
Comm.
SubdNfsion/Plat Name/Short Plat Number
)14
Assessor Parcel Number
Lot
Block
Plat Number
2,3
Pertinent File Numbers,
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft./ Acre)
Depth
Frontage
Frontsetback.- ;'
Left Setback
Right Setback
AearSetback
R/WWidth
Addltlonal Information
Z
0
Square Footage
C� k
0
LL
Number of Bedrooms
m
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Group
Type