1985, 05-31 Permit App: 00005691 Pool•
y
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 Owner's Name
(last)
Jones Aro i
2 Project Address (not Mailing Address)Road Name
IIIA, gasf- $(,4*,¢de,
S CI Community State
&V a. -)
4 Assessor Parcel No.
Block
(�
of
(first)
o 444a -I I Oa- 41
5 Sic Code Zone Act.*
e Dwell *
7 Set Back -Front
-1(/91-7 NG
16 Architect Firm Name
Space Zip
A) lCepadr»s )se Only
His. 1Comm
Subdivision/Plat Name
Myron &s -61C A)6 1/
?Rao b
* * ♦ DEPARTMENT USEONLY * * *
No. of Buildings
I(IS -1 (1/1)S-2
Zip I City
Contact Person
Zone c—ity
Rear
Census Tract
Module No.
Project No.
564i
Depth 6 1 1 Frontage
Initials
Street Address
State
Prime
)
O.fMractor Finn Name
Zip
Contact Person
I"
Phone if different than above
)
Street Address
ILicense No.
State
Phone
)
8 Owner/Agent (If different than *1 above)
9
Zip I City
12 Review Required I Plan Check (YIN)
15 TypeWork
14 Describe Work
10 Applicant Name
❑ Bldg
❑ Fire
I State
Intone if different than above
1 )
IDual ons Address
Phone
)
❑ MH
❑ Demo
SWIYfnuk\6- POOL
tt Zlp I City
Lender
Oth r(Y!N)
❑ New
❑ Add/ Alter
SEPA Exempt (YIN) I Date
❑ Replace
0 Move
Street Address
IgC Other
state
Phone
(
Zip City
Contact Person
Additional Information
IStreet Address
IStets I Phone
Phone if different than above
)
41"-
•
DEPARTMENT APPROVALS
This io nota Permit
DU
Application Type
(Standard unless
otherwise Indicated)
Fast Track
Early Start
(Indicated approvals required in either "release" or 'release with conditions'
space prior to permit issuance.)
Release
Release
w/cond 1
Hold 2
/ r
.�.
`vk8
mJ
Environmental Health
W. 1101 College
Room 200
El Commercial; 0 Residential
❑ New Construction; El Bldg alteration/addition
❑ Additional structuree� v`
a[
APPLICATION # /r/ 5'970
b�---
Conditions / Comments
-
0
Planning/Zoning:
N.721 Jefferson
Conditions/Comments'
❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
D Setbacks; 0 lot w/d; ❑ lot size; 0 use/zone'
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
❑
Engineers:
N.811 Jefferson
Conditions / Comments
0 Commercial; 0 Residential; 0 Flood Plain;
0 drainage 0 new access/approach; 0 fence;
❑ road Improvements
❑
Utilities:
N. 811 Jefferson
Conditions / Comments-
0
Other:
❑
v
Plan Exam
Fire Prev.
Conditions /Comments'
c
m�
25
o
a
— c
Et o
- E
LL
Project Representative
Agencies Performing
Telephone
Special inspection:
1
2
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
/6/.37
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