1987, 01-30 Permit App: 87000295 Reisdence ....
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PERMIT)
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(THIS IS NOT A „,„. , 1,,kii.„,..:-- _ ,-,,AND
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YOU UNDERSTAND BUILDING ERMIT A1-1-'
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-'-- ONLY THOSE PLEASE PRINT ANDC0MPLEPI
building ,
i USE Project Nu
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(Please return this original and your ARLAST AREAS F FOR DEriF:3\TRINIENTA .
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Owner's Name
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Project Address(Street Name&Number)
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Assessor Parcel Number Lot Block Plat Number
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Number .lJng Units Number ofErild•ngs Lot Size(Sq.Ft/Acre} Depth Frontage
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DEPARTMENTAL REVIEW
Cond.
Approved Approval Hold
A + Environmental Health Application M g'7 -00 33 1 �_'6 �"' 30-sly
; W. 1101 College (1�.. `40
Room 200
Planning/Zoning
❑ N.721 Jefferson
Engineers 1/46
/� N.811 Jefferson 77 i:71/A-4.ZZ- 7"I
Utilities I
❑ N.811 Jefferson
Plan Review/Fire Prevention Y
IDN.811 Jefferson
19'
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 a.ent to compile said application is true and correct.
Signature X !A.... - Date I -o -� -7
*******************************************# ******************** k**7Q******#***
* INFCRMATICN wCRKSHEET
************************** ****************************************************
* GENERAL INFORMATION *
*
* PARCEL NUMBER :
*
* STRT ADDRESS :_
* CITY/STATE /ZIP :
*
* SUBDIVISICN :
*
* BLOCK :__ LOT:__ ZONE:____ DISTRICT#:
* *
* LOT AREA:__ F/A : _ WIDTH: _ DEPTH : R/W : *
* *
* # OF BLOGS :__ _ # CF DWELLINGS:_
*
*
PHONE:____-___ *OWNER : � - - ---
* MAILING ADDRESS : _
-
* *
* CITY/STATE/ZIP :
*
* CONTACT : -_-__
PHCNE:____-_-_-
*
*
******************* ***********************************************************
******************************************************************************
* PLUMBING INFORMATION --
* CONTR LIC#:___ ________________
*
* CONTRACTOR :-------_____-- -_ PHONE:_ -____--___ *
* *
* FIRM NAME :
*
******************************************************************************
* MECHANICAL INFORMAT ICN *
* CONTR LIC#:_ _
*
* CONTRACTOR : __ _ PHCNE:____- --_- *
* *
* FIRM NAME :
* *
* ELECTRIC:_ GAS : OIL: COAL:___ WOOD: SOLAR:___ HEAT PUMP:___._ *
* *
******************************************************************************
*******************************************%4**k4.*;kik******************************3
MECHANICAL FEES PLUMBING FEES
ITEM DESCRIPTION NUMBER CF ITEM DESCRIPTION NUMBER OF
PROCESSING FEE YES OR ) PROCESSING FEE YES OR C
DUCTWORK SYSTEM _ TOILETS 2.
wOCCSTCVE/ INSERT SINKS _-7
__
GAS WATER HEA TER _ SHOWERS
GAS I-TG EQUIP<10C,000>BTU
_a__ BATH TUBS
GAS hTG EQUIP+100,000 BTU _ KITCHEN SINKS 1 _
GAS PIPING - I OF UNITS �____ DISH WASHERS _
HEATPUNP 1-100M ETU GARBAGE DISPCSAL
HEATPUMP 101-500P BTU CLOTHES WASHER
HEATPUMP 501-1, 000M BTU UTILITY SINKS
HEATPUMP 1 ,001-1750P BTU ELECTRIC WATER HEATERS _ 1
HEATPUMP +1 ,750M BTU _ FLOOR DRAINS
REFRIG 1-100M BTU FLOCR SINKS _
REFRIG 101-500M BTU BAR SINKS _
REFRIG 501-1,000M BTU ROOF CRAINS _
1EFRIG 1 ,001-1 ,750M BTU LAWN SPRINKLER
REFRIG +1 , 750M BTU SEWAGE EJECTOR _
AIR CONDITIONER 0-3 HP WATER SOFTENER
AIR CUNOIT ICNER 3-15 HP URNAL
AIR CCNDITICNER 15-3C HP _ DRINKING FOUNTIAN
AIR CCNG IT ICNER 30-50 HP
AIR CONDITIONER +50 HP -
VENTILATING FANS _ G�
EVAPORATIVE CCOLERS
HOODS _
CLOTH-ES DRYER
RANGE
GAS LOG
UNLISTED GAS APPLIANCE
AIR HANDLER 1-10000 CFM _~ _
AIR HANDLER 10000+ CFM
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