1985, 08-16 Permit App: 00006911 Pool BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Ow (last) (first) (m)
apartmentsJae Only
�F� ref Ras. J Comm
2 act frees(pot Mailing Address)or Road Na Space
f �0/CGa. Zip
3 City/ mmunity State/i f Subdivision/Plat Name �J �30
r e i
W 4- L ` k �i es r_.4) kR6
4 Assessor Parcel No. Lot I Block
2 7"i' O 9C3 * * * DEPARTMENT USE ONLY
5 Sic Code I Zone Act.# Zone c Project No. 6��
6 Dwell# I No.of Buildings S LIPI°
./Acre oath/
OMr p Frontage
7 Set Back-Front (L))S t r(R)s_2 Rear Census TractModulelNo.
/`° k sInitials
* 16 Architect Firm Name77'"'
Street Address
Zip I City I State Phone —
( )
Contact Person
Phone if different than above
( )
tractor Firm
Street Address
And4 / - u 4k J C- /3 1–L Y. '.e–sltAlllG—
zip �Q��` — j sf
L if �4 l Ga c-e`"C' df-4) . State Phone
' 9) s,9 s �.� ..
Contact �/ Gf
-�/. �P ra ee� o ;r .
No. Phone if different than above
//`'3„-C [/J.T"' I � `i
8 Owner/Agent(if different than#1 above) I Business Address
9 Zip I City I State I Phone
( )
12 Review Required I Plan Check(Y/N) I Other(Y/N) SEPA Exempt(Y/N) 1 Date
15 Type Work El Bldg 1 ❑ MH ❑ New R
Replace I ,� Other
❑ Fire 0 Demo I ElAdd/Alter
E7❑ Move
14 Describe Work S /
)/,i',1/Ail a c_..
10 Applicant Name I Street Address
11 Zip City State Phone
( )
*
Lender
Street Address
Zip City State —
Phone
( )
Contact Person Phone if different than above
( )
Additional Information
DEPARTMENT APPROVALS
This is nota Permit
Application Type
(Standard unless (Indicated approvals required in either"release"or"release with conditions"
otherwise indicated) space prior to permit issuance.)
Fast Track
❑ Early Start Release
Release w/cond 1 Hold 2
Environmental Health ❑ Commercial; ❑ Residential p d,7t.
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200 ❑ Additional structure;
APPLICATION# C `67 7
Conditions/Comments:
Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; .
❑ CU,variance,zone change;shoreline; ❑ fence;
LI Other
Conditions/Comments:
❑ Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain; I
N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
❑ Utilities:
N.811 Jefferson
Conditions/Comments:
Other: ( ( I I
Plan Exam
Fire Prey.
Conditions/Comments:
ci
c
�❑
Project Representative
Telephone
a Agencies Performing Special Inspection:
O 1.
co t
H E 2
r) O
u_
3.
1 indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
S-
k F4/
T r .I'
i .- ----- --- - - I ,r i 1 V
r
1 I NI
I iso d'
� 15 ,(,,Idcji',
/,�,.,-� /1 — I I , j' Ut) id
-
9� SF,a 1
/ ;&
'Y,33 3'. 1 [ I I ,j' t1 Nal-
1 I I \ ji \ , , i '1 ' `1_ )
---;9' 1
I I 0. vs) 4 1
4414 ,,
dt. ......, 0
ATI° T,
.. 1, ,
._
,,s, > .
,„,‘„, ,s.:07,.
,Kis T/„✓e i„,,se
2.71 .