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1988, 01-12 Permit App 87001485 Pool
(THIS IS NOTA PERMIT) BUILDING PERMIT APPLICATION WORKSHEET 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 AREA 7- Project Number Owner's Name LAST FIRST MI /OES3 ART I/(IX Project Address (Street Name & Number) , Zip so, Airec. 1W/f 6JD j, SPIP 4 ff5 14/45*r ?y (o Applicant -IN ' POOLS /4 , Address ,vS-ASo /RC-)4 sT— City ��7/� yn / Oaf tT4/ Stated / U 4 . Zip s� +y / A: / Phone Phone y�q. q� (6 C!/ ) OT ` $7/ Business Phone Contractor/Agent _.4—A1 P VA fert94 5 /NC . Address Al/,moist) /FE- 0 City JP©/ C4 State 4s, Zip 9 . 7 Phone e?) q ref/ Contact 1345 WASH License Number (Required) /rye i .1a7 pr Business Phone ( ) 44£y - 66 7x Architect/Engineer .. /tPx/AL Peels INC t Address City State Zip Phone ( ) Contact Business Phone ( ) Lender /�� GYt4. Add ess City State 1 Zip Phone Describe �Work t—/v5i( / /vifvl!/t fo/+ `1 �Fp L Res. Comm. Subdivision/Plat Name/Short Plat Number Assessor Parcel Number 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 Frontage Front Setback I Left Setback Right Setback I 1 Rear Setback R/ W Width Additional Information Square Footage 2 2 0 H 2 cc 0 LL _z 0 z 0 5 5 m Number of Bedrooms Building Technician Date Group Type DEPARTMENTAL REVIEW Environmental Health Application # 1 / 4 / 7 W. 1101 College Room 200 Approved Gond. Approval Hold Planning/Zoning ❑ N. 721 Jefferson Engineers ❑ N. 811 Jefferson Utilities ❑ N. 811 Jefferson Plan Review/Fire Prevention ❑ N. 811 Jefferson Other (SEPA/Critical Material/etc.) Fast Track/Special Inspection information Project 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 Dale Show on Site Plan: Lot Dimensions Existing Structures Proposed Improvements Structure Setbacks Easements Septic System (s) Water Lines Sewer Lines Fences, Wells Driveway(s) Right of Way Width(s) Names of Fronting Street Flanking Street DR/FrPAW) Additional Information: Landscaping Drainage Plan Hydrants Topography Lighting Signage Shorelines Highwater Mark