Clinton Rd S 3015 Noll Coast Inc - 6 Plex
BUILDING PERMIT APPI.ICA7ION'WORKSNEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
(Please return thts original and your building ptans to the Department oi Building and Safety)
Urst (m) ,
1 Owner s Neme past I meM lbe Onl
Y
° , V `'l / ( C V A. lt_, -k I Camm
■
2 Pra~ect A~lress (not MaiUna ress) aFoad Name ~ SR~ ZiP
~~i ni ~G n) A c/
3 Ci fComrnun(ty Stele $ubdlvtsiOnlP19l Netne
A
L.) ~ ~ l ~ 4 a
PBrt~el NO lAt 8Lek
rBac6DAoe Z~ S ~q 2 Y~ QEPAATM ENT LSE ONLY e zo~att ♦ -K{~•g E Project No No vt Bufldinps S~ Ft /Acre Oep1h Fronta~pe
c-From m (L►S-1 tRfs-2 173 oeneus rrect Nitooute No I~u+a4~
7 1:5 1 /0
~
• 18 ett Ftm+ Name SirW AGnraQe
/ A C) h/ -Q
Zip ~ 7"ne s0~ y2 G v
~ Phone 11 dlHefent tlsen above
~ I
Ff) tor rtm NamQ Street AQd►ees
~ l 6^ C+
z+o Stdo ~ 6
~ 2 O
~ ponw pamn Uoerti+e No 4,2 Phone If dillerent than ebove
8 OwnerlA9enr(if OiNerent then 01 abot►a) Bueineas Addresa
9 2ip Gty S1ate w+nne
l }
12 flevFew Peqwred Ptan Chedc (Y/N) Olher (YIN) SEPA E,cempt (YIN) Date
15 Type WOrk 4kf- Bldp D MH New ~lace OOther
¢ Fite O pemo ^ AddlAlter ❑ Move
14 brl Work
sc 16 x ~ C
10 Applirsant ama Stroet Addresa
tt zip City State Phone
( 1
: Lender Slteet AddresD
Zip Cily StBtC Phone
I a
Conlarl Pmon Phone if ditfersnt than abave
l 3
14QdIleC/1o) 't1'Hfr}o1iE rD
7 & 4eis
~
~
" GEt~ARTME1.°► APPRO1fALS
This Is nat a Permi#
Arpifcatt&4 Type
(Srandard unless (tndlcated aQprovals requlfed In elther "reiea9e or Rrelease with candiHons' ~
otherwlse irzdicated) spne prior ta perrnit Fssuance
D Fast Track Rglease
0 Early Start Flelease w1c4rtd 1 Hdtd 2
. ~
~ Envlranmenla4 Heaith Ll C-ommercial, p ResidentFal
Wi10# Co[I$ge M Nsw Constructiran, E7, Qldg aSteratlohladdliton 1
. 1
Riwm 200 ❑ Addltiona1 strucfure,
APPL#CATIOM q --~CoriditEonstComments
~ PIannlrtglZonirtg! 04 Cammercial, ''J Cwt of Exemptton* t] Frontage, ~
N 721Jeftarsnn Ci 8etbacks, C) lotwld- F- 1Qtsize. ❑ uselzotte. ~
U CU, varEanc+2, zone change, shor$!tn$' D#ence,
0V t!'
Cor~dltion$tCommer~ts: ~ c~.-~:. ~ ~ L
.
~
~ Er~ineera: 0 Cotnmerclaf, CI Rftkdentigl; C4 Fload Pl$In.
N 511Jeftemn 0 drainage ❑new accsslapproach; 0 fence,
Ll road impravements
Corrd ltiana 1 C:o rnmente.
F ~
~ utiltli" ~
N ell JerieMan .
Gbrtciit Ivns 1 Com men ts
. ,
Othrst'• ;Iiy
~
0 Ptan Exarn
Flre Prev
OondI tfans I Cam men ts
a ~
~ Rraject Representalive Telsphone
Agencies Psrtorming Sp$+CraI lnspecation
~C 0
~ ~ .
~ E ~
li. ~
3
i rndWfe a6ove ar attach cond111ons r$latlve !a ttnal an bullt eppravei
2 Indtmte above or attach ressons for hvtd
Con[bc:i, Net
~qm bus[ nea-i Nawg
_._._~1..
Addre~e 7-A _P_~f I Acldr`bs
Phone 41i L_ Phune
Count Contact Nereun
Y r.. Photie No 5~-36t~c~
Cl)MlfE.\C iAL dU L!JDi N(/ pLItM Il* KtV lEW
?hie bul lding permit revlew is !n[ended to appraise you of [he iwpruvemetitti ( ruadway. eide-
va11c, curb, etormwater, etc. ) which muet br eonstcucted,in aesoctation with yuur building
permit. Thie checkl.ist vill be fflle`d out by the Engineer'e eCaEf and a copy will be re-
lurned to you at the time that the permit ia initieled by the Engineerf ng Departmeat. All
cequiremente shsll be completed prioc to Leeuaoce of the building permit,. All unchecked
boxe• reyuire additional reeeerch or i+nformation to make e determination.
I. Storuwater Dtainage Coneideratione
'k. ~+e+er gui'~`eT~nes"Voc "Stormwater Management 1981" both on and off _ te.
l. 208 Coneideratione*~ Ye• Na
2. Flood hazard zone coneideratione** L e I~i
3. Storm Drainege Plan Yee ~,No
II. P1anOiu,~ Action c C,
1. Resoae, Cooditional Uee or Variance oA property
t2r VYes e LJ No
2e Aire requiraiaente ot plaaning action incorpocated Li No
into oite plan
III. gjht og Way
1. Ooe• pet0it neceeeitete B.4.i1e dadicstioo Li Yes
Na
Z. Did =mo chsnge require R.O.W. dedicatioe CL't oVT-0'y Yee ti No
%~D,
3. Badiue at corner ' ~ Yes Na
Iti• County Road Iprovemeoce
~
1. 8oad• aeed to be impsoved. Hov wide _ Yes a Ido
2e Cutrb ~ Yes a No
3. CRP/eID egreemeot (Copy of deed. contract, or ~ Yes ~ No
title repor;t required.)
4. Plane for improvesente provided ~ Yes ~ No
5. Sidevalk 0~~ Yes p No
v. p k ~~-i N~ p~
~
ar ia,~ plan d Aroach Location
1. RevieM end sign ofE by 'lYaffic Yea ~ No
2. Approach Pe rmi t f com Eng! neer le Of f ice U Yes
~o hi ~4C~
3. State or 'Ci ty stgn off Yes ViNo
4. Is this coad un 6 Year Plati ~ Yes /No
VI. ULI°D Agreement: ~ Yes ~ Na
VII. Field Review: Pretiminary Conuneuts
- ~ _ 4~ ' .~...w- .~...~.~~e~ ~
~ ALI land wtth[n [he Aqiif ter 5eit'tiltf ve Arei. wltere dtaemed ft•+sihlt- I,y t fit, (alttilty Hiigi-
nerr, shal 1 tncorptiracts stormwatksr itt•;jt,a#L1ei1 tit inlf tj4a[ts ttie potR•iiti o1 ftir gi-►mOw,ite,
degragNtion. (See (:~~icl~,•lt~~~ti f+ir storn,witrt Maisagement 1`91it, Spok.i,i. lioard -it (.mirity
Cnmmi•a%i~i~~t'' ~ kt•-tiI iai,m No. 10-I W21 .1ti ai11endiod.
lI11- Ili1rp-1•f of Itood i11iit1i /,,m1' isvlltbll` 1• f!1 IT111111111"I/1s
l`l FI( ai'!'a,~+'+II ~1! !t f'it1e11~ ~tj 11' i H1.II/1/1a11"y f11.1~~1 1)1) fI Il• 11 ( i11 1iteI11~ % h1j' i lt'1'rl-4
fiff I 1 l•. ( ~trr J~• 1~1~ ~ 1lS~ ~1~ C'O1111t V ( 11111111I 1-4 I t11i/«1' '1 Rf"7l1I t11 iot. N, 1. 41
-1 }t~~ 1♦
i~lll~ t~ ~f • ~
. 1 ~ .
• DEPARTMENT APPROVALS
This is not a Permit
AppUcation Type
(Standard unless (Indicated approvals requlre0 In either "release" or "release with condltlona"
othenw" indtcatecl) space prlor to permit lasuance ) ❑ rFaat Track Release
0 Early StoO Release w Icond 1 Hold 2
- - -
Emrironmental HQSIth C Commercfal, p Restdentiel
W 1101 Cotlepe CJ New Conetruction, O Bldg alteratlonladdltlon
Room 200 C7 Additlonel structure.
APPLICATION #
Condltlona/Commenta y,
o ~ P14inAfno/Zoninv• O Commerciel, O Cert ot Exemption, O Fron"pe;
N. T21 Jefterson O Setbacks, ❑ lot wld, O lot alze, 0 uselzone.
O CU, varlence, zone change, shoreline, D tence;
0 Other -
GbndlliORelComments.
f
<
Aft
~lmwn; C3 Commerclal; Ca Residentlel, O Ftood Ptaln,
N 811.lefterson Cf dralnags O new eccesslepproach; 0 tence; '
0 raad Improvements
Condllions/Comments. ~
~ utlmia:
N 811 4eNere6n
~ OondltbnaJGommente Othw: '
❑ Pbn Exahn Flta Pr+nr.
CaMitlorm/Comments. - ,
~
a
c~ 0 PiroJeot i3epreaentative Tetephone
I AQeridee Performing 6peafal lnepectlon•
~
r ~ Z
~ ~
LL C
3
1 Irbkate eDovs or stfach aondlUons ntative to Ilnal as built approvel
2 Inaiab abovs or atbeh nssone br hold
. i
a .
BUILDING PERMIT APPLICATION V!/ORKSHEET
e
<
PLEASE PRINT ANO COMPLETE ONLY THOSE PARTS OF THE FORM YOUSUNOERSTAND
(Please return this original and your bullding plana to the Oepartment o! 6uildlnA and Safety) ~ r .
, + ~ ■ ~ v
1 Gwner'e Nffine past) ttirst) (m) Oepertmertt tbe Only A4P c 0 c- ~b Ci01f1T ef
Z Addresa (not Malling #dVm) ar Natne S0~ Zlp ~
Wj!n
3o/.5 I.. Il A(ToN PC/
~
9 G /Qonrontq+tty 81ete SubdlvlshDn/ Nerne ~
f 0
U..) <00 1 ti ~ O O
' 4 I~roel No lol 8!op~
2 y Li ♦ o ~ OFPARTMENT USE ONLY
S ft cbde i zone Aot I Zane ~ P~rojeat Iio . ~
~ 44P ~
8 Owell / No o! 8ulldlnpe - - ' gq,ft lAare Oepih Frontepe,
.
7 Sed 8eak-Fron! (L)S-1 (Rj~us T~et Mcdute No Inltlel8 ~ r~~
t o , a Ci
. • > ,e Frm+►~o SIrM aaar= °
Y
1 ~ `f
DA Z 1~ V c ~1 1~ St~ Cl2 t~/'~ 6C)
CAmM F:
rlarm wom n dtnerene mm ecw"
\AJ
~ ~f~6~bir {tn Na~t~e 8irest ~s ~ a ~
~
~
~
MP
E,
~ •Z, Q
p
'`~o ~ . , ~
oon~aae E~raa, ua~e No ,L ;2 w,o„e ltaittere+s nta++aba►e
o4rr a ko.r Z ~S (gfjc) .k
~
1
' 8 owwl at aifferent ehan w above) 8„alrress Adarm
~
~ - - , ,
~9 Zip - - ` Wry - ' gtate phane ` :
~ iZ Review inutred Phan CReok (YINj Other (Y/N) SEPA Exempt (YI,N) Oate
, - itr - ~ 18 TypelNorlt ° `-p Bldg 13 MH _ Nsw 0 Replace ~ p OtAer ~s
, ❑ Flra O Oemo O Md/Alter ❑ MovB
~ 14 lba%%Wk
`
` ~ , A~• ~ ~ ~t g~
-
'tO ADpi _ SVW Addreas
,
o - _ I 0
11 ~ City fttB P"M 1
P
WmY` AdY7YYO :
1
I Ep ' Wry phom ♦ '
i QorltaIIi POamn PhOn91f diHe►6nt lh6fl BbaYe ~
l )
~ Addlflonat Infoimallan
, •
_a
a
t