1986, 07-18 Permit App 00012742 Residence, Garage(THIS IS NOT A PERMIT)
BUILDING PERMIT APPLICATION WORKSHEE i`
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
SHADED A
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Project Number
Owner's Name LAST r I RST iv!!
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Project Address (Street PCame & Number) Zip
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Applicant I.Address
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City
State . Zip
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Phone
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Business Phone
( )
Contractor/Agent
i
Address
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City
Sta e
Lti
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Phone
( ) 92.7_7 0
Conte
W'D-a CK'a-"iAi
License Number (Required)
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Business Phone
( )
Architect/Engineer�/ f1�j
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Address
City
State
1
Zip
Phone
( )
Contact
Business Phone
( 1
Lender
Add ess
City
State Zip
Phone
Describe Work
1(? n1 Lx) C .F- .-
Res.
Comm.
Subdivision/Plat Name/Short Plat Number
,cot 1
Assessor Parcel Number
(� 4 4 - CI 04
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Lot
Block
Plat Number
Pertinent File Numbers
Zone
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft./Acre)
Depth
f 6
Frontage
(oy . C,4 1
Front Setback
Left Setback
1
Right Setback
Rear Setback
R/W Width
Additional Information
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f BUILDING INFORMATION I
Square Footage
IF = j i b
Number of Bedrooms
Building Technician
Date
Group
Type
DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health Application # 3 `d 5'5-1? (%ram
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W. 1101 College o
Room 200
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Planning/Zoning
N. 721 Jefferson
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Engineers /�,
of �/N,�s4/ LGel ��/€04/-
N.811 Jefferson tf,v�!
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Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/Critical Materlal/etc.)
Fast Track/Special Inspection Information
Protect 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 agent to compile said application is true and correct.
Signature Date
(tievadi
Lot Dimensions-
Existing Structures
Proposed improvements
Strt ctareSethacks
Easements
Septic System (s)
Water Lines
Sewer Lines
Fences, Wells
Driveway(s)
Right of Way Width(s)
Names of
Fronting Street
Flanking Street
Legal Description
Scale:
. Rovis on
iniarma
Landscaping
Drainage Plan
Hydrants
Topography
Lighting
Signage
Shorelines
Highwater Mark
41l
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Leg., /` Ur /0,4:77, ..
PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
IProject #
Owner's Name Last First MI
a4'0 6 /
Project Address (St t ame & Number)
JV5 2-06 I2 2
City
State
Subdivision/ Plat Name
Assessors Parcel #
Lot
Block
Plat #
Applicant
Address
City
I State
Zip
Phone
Business Phone
Contractor
Address
City I
State
Zip
Phone
Contact
License #
Business Phone
Describe Work
BarSink(s): 0
Drinking Fountain(s): Q
Floor Drain (s):
Washing Machine(s): I
Dsh Wshr(s): /
Garb Dlsp(s):
Kit Sink(s):/
Lndry Tray (s): j
Sew Eject (s): /
Urinal (s): C)
WtrCloset(s):
Lav(s): 2
Shower(s): 7
Tub(s): /
Bidet(s):
Other: Type;
Waste/Grease I nterceptor(s):
Sewer Y N Septic/Health No.:
Electric Water Heater(s): j
!
Drains -Roof:
REPAIR OR ALTERATION: Drainage, Vent, Water Piping/Treatment: Y N
Lawn Sprinkler System (s), including backflow device on any one meter:
Vacuum breakers or backflow devices In excess of line 16:1-5:
(Or) 5 + :
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR AGENT DATE
APPLICATION
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Project #
Owner's Name Last First MI
—ee-' =-h 4 -5 -7,qt S-E'.c /�.•—.
Project Address treet Name & Number
4t 5`7--e..2 �..f✓,-s-
City
State
Subdivision/ Plat Name
Assessors Parcel
Lot
Block
Plat #
Applic ^t
Address
City
State
Zip
Phone
Business Phone
Contractor
Address
City
State
Zip
Phone
Contact
License #
Business Phone
Describe Work
Fans
Evaporative Cooler
Hoods
Electric Furnace/ Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
Air Handling Units
0-10,000 CFM /
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
1-100,000BTU
10%,,L00+BTU
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
APPLICATION
OWNER OR DATE