ALKI E 6015 SUTHERLAND & SON CONST SCALE HOUSE
r
; - (THIS IS NOT A PERMIT)
~ • ' BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
COMPLETE IN INK
(Ptease return this original and your building plans 1o the DeDartment ot Building and Safety)
SHADED AfiEAS ARE FOR DEPARTMENTAL USE
ProJett Numt+ar
i1w r q.s Name ~ LA ST F I NS t M I
Prol 00, . I AUdrese iStreet Name Numpe ) Z;p
• _ / ~
a,~ iant /~dras ~
G State ~ ZID Prwne I
(51:5
Bwineaa Ptwr►e
1 )
- - ~
(---jrtra:tor r agent Aadress
5iate ~ Z,p ~ Pr.one
~ 1 1
Contecf t Liutnan Num"r 1P.eQuUed) Busmess phons
4
~ ( )
A~C +leci i Enqir+eaf ~ I►ddt!!a
_ j,Y ` z+p phwe
~~•~N~ ► ~fGG -~'~c,
emnass Phone
lenCw ~ MQrese -
G tir State 2i p Pnone
Ouxrtoo Wak . Res. Comm;~ i
~C'.rA L c u S 6- 07
~C ~Cn
Su~Clvis,or, Plat katMll Stlort Pl1l NurttGf
E A s-T 5 Po VA hre S r/~ or- Aseeasor Parcel Nurntw Lot 81ock Plat Nurttber
t 3533 - 13if
PwtM~►t File Nur*~bars Z~e Oomp. Ptan (bn~us Tract
Number ot pwelitr►g Units Number ol Bu~ ~nga Lo1 SJze (5q. Ft./Acre) popth frantave
PI' 2rfl
Frmr se+e,cx Lsn Soteack aignt setcack cWW setbeak R! W Vlfidlh
AdditicnaJ tntamatim Square Foatape
~ ~2- ~
Z
O
H
Q
- - ~
CC
O
LL
Z
2
~
J
f _ M _
ID NUrTlbBr al SgCfpC,l1 3
8uiidin9 Technjccan Oa~e C,r~p Y/~
I 1- rC- .5 8-2 V~1
a
DEPMR1 MGNTAL F'tEY 1E►tY
Appr-oved Cond. ~ Modd
Approvai
1
Environmental k#eaath Appkation 0
71 W. 1101 C011098 - ~
ROom 200
Pl8f'lt1iRg/Z01'liilg
N. 721 Jefferson
~
~ Engirtser! ~
~
N. $11 Jeffet5or1
. ~ ~ ~ .
10tilftles
fian RevievwrfFlre P'reventlon 16/'~`PT +
y IS1. B1 IJ+atf+ets+Dn ~
Other(SERAfGritkel Matsr#dl/etc.) I ~
~ .
~ Fast Truvkd5pecial Inspedion Informatlon
Prajec! F#epresentadFrre Phone
Address
I wfi#y that I hawe exarnine# W3 application and $tate that khe inficrrmation contained, in Jt and subm~~~e,,f
by me or my agenC to compsle said a,ppllcatirn is true and correct.
' -
r ~ -w • 1i ~