Loading...
05-100731 • City of Federal Way ConuuunityDevelopment Services Building - SiIgle Family Permit #: 05 - 100731 - 00 - SF P.O.Box 9718 Federal Way,WA 98063-9718 Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050 Project Name: ODEYCHUK Project Address: 30502 24TH AVE SW ,l7Parcel Number:889420 0050 Project Description: NEW-Construct a new 3409sgft,2-story residence ith a 874 sqft attached garage and 46 sqft deck, including plumbing&mechanical. ****4 bedroom; ',600,000**** Owner Applica- t Conti ctor Lender VICTORIAN CONSTRUCTION*VII< VICTORIAN CONSTRUCTION*VII? VICTORIAN CONS •UCTION*VIE PRIVATE LENDERS GROUP 6823 PICNIC POINT RD 6823 PICNIC POINT RD VICTOC*032DJ 03/11 16 411 108TH AVE NE SUITE 520 EDMONDS WA 98026 EDMONDS WA 98026 6823 PICNIC POINT RD BELLEVUE WA 98004 EDMONDS WA 98026 Includes: Census category: 101 -New si #1 #2 _L #3 1 #4 Construction f e R-3 U � Occu anc Grou Yp Type V-B T eV-B Occupancy Load Floor Area(Sq.Ft.): 1 - _ 1 1st Floor Proposed Sq.Feet 1506 2nd Floor Proposed Sq Feet 1903 Basic Plan No Census Category 101-New single family houst Occupancy#2-Construction Type Type V-B Deck Proposed Sq.Feet Fire Sprinklers Required No Garage Proposed Sq.Feet 87 Height of Structure 25.5 Mechanical Yes Occupancy#1 -Class R-3 Occupancy#2-Class U Plumbing Yes Total Proposed Sq.Feet 4329 Zoning Designation RS 7.2 Plumbing Fixtures Description jQuantity Description [Quantity]L Description -1QuantityJ Bathtubs 2 Dishwashers 1 Laundry Washer Outlets ] 1 _ L _ _1 1 I =— — _- Lavatories !� 5 Other PlumbingFixtures 2 '�howets � 1 Sinks 1 Water Closets 3 r Water Heaters 1 Mechanical Fixtures Description jQuantity Description 1Quantity Description Quantity] I Ducts — 1 Fans — ] 5 Furnaces 1 1 Gas Logs 2 Ranges - llr- 1 IL CONDITIONS: *Right of Way Permit Required For Install of Driveway Approach and Possible Relocation of Wheel Chair Ramp,Street Tree& Sign.Contact Public Works Department 253-835-2725. Vr - r , •* PERMIT EXPIRES itumary 4,2006. Permit issued on July 8,2005 I hereby certify that the above information is correct and that the construction on the above described property and the occupancy and the use will be in accordance with the laws,rules and regulations of the State of Washington and the City of Federal Way.�aOwner or agent: �'i1 " "1< *e4'41 Date: 7�'� C:,s— City of Federal Way Certificate of Occupancy This Certificate issued pursuant to the requirements of Section 110.3 of the Uniform Building Code certifying that at the time of issuance,this structure was in compliance with the various ordinances of the City regulating building construction or use. This certificate is valid ONLY when endorsed by City staff. Tenant Name: ODEYCHUK Permit number: 05 - 100731 -00 Address: 30502 24TH SW #1 i IF #2 1 #3 _#4 -- Occupancy Group R_3 11 U I Construction Type: _ _ Type __ 1 Type1'�— T eV-B V-B Occupancy Load: 1 i _FA--- _______H PFloor Area(Sq.Ft. : — Owner VICTORIAN CONSTRUCTION*VIKTOR ODEYCHUK* Name: 6823 PICNIC POINT RD Address: EDMONDS WA 98026 Building Official Date The priority focus in the review and inspection made by the City prior to issuance of this Certificate was on those matters which experience has shown most severely affect the health and safety of the general public. Although the City has made as complete a review and inspection as is reasonably possible(within budgetary time and personnel limitations),the City neither guarantees nor warrants to the owner/occupant or to any other person that this Certificate evidences strict compliance with each and every ordinance or regulation of the City or the State of Washington affecting the construction or use of said structure or the land upon which it is situated. Such compliance is the responsibility of the owner and/or occupant of the premises. L - 4 f t City of Federal Way Building - Single FamilyPerm#• 05-100731 -00-SF Community Development Services P.O.Box 9718 Federal Way,WA 98063-9718 Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253) 835-3050 Project Name: ODEYCHUK F ILE Project Address: 30502 24TH AVE SW Parcel Number: 889420 0050 Project Description: NEW-Construct a new 3409sqft,2-story residence with a 874 sqft attached garage and 46 sqft deck,including plumbing & mechanical. ****4 bedroom; $600,000**** 10/17/06 Add 210 sf to deck area** Owner Applicant Contractor Lender VIKTOR ODEYCHUK VIKTOR ODEYCHUK VICTORIAN CONSTRUCTION PRIVATE LENDERS GROUP VICTORIAN CONSTRUCTION VICTORIAN CONSTRUCTION VICTOC*032DJ 03/11/06 411 108TH AVE NE SUITE 520 6823 PICNIC POINT RD 6823 PICNIC POINT RD 6823 PICNIC POINT RD BELLEVUE WA 98004 EDMONDS WA 98026 EDMONDS WA 98026 EDMONDS WA 98026 Census Category: 101 -New single family house, detached Includes: #1 #2 #3 #4 Occupancy Class: R-3 U Construction Type: Type V-B Type V-B Occupancy Load: Floor Area(sq. ft.) 0 0 0 0 Additional Permit Information New/Additional Sq.Feet- 1st Floor 1506 New/Additional Sq.Feet-2nd Floor 1 1.1 New/Additional Sq.Feet-Other 0 Plumbing to be Incluled9 ..71141:10.1 es New/Additional Sq.Feet-Total 4539 Zoning Designation .R 7.2 New/Additional Sq.Feet-Basement 0 Basic Plan? t�c. 4, .. " N t Occupancy#2-Construction Type Type V-B New/Additional Sq.Feet-Deck 256 Fire Dept.Access/Hydrant Loc.Needed? No New/Additional Sq.Feet-Garage 874 Height of Structure 25.5 Mechanical to be Included? Yes Occupancy#1 -Class R-3 Occupancy#2-Class U Mechanical Fixtures Ducts 1 Fans 5 Furnaces 1 Gas Logs 2 Ranges 1 Plumbing Fixtures Bathtubs 2 Dishwashers 1 Laundry Washer Outlets 1 Lavatories 5 Other Plumbing Fixtures 2 Showers 1 Sinks 1 Water Closets 3 Water Heaters 1 CONDITIONS: * Right of Way Permit Required For Install of Driveway Approach and Possible Relocation of Wheel Chair Ramp, Street Tree& Sign. Contact Public Works Department 253-835-2725. l ' P MIT EXPIRES Sunday, April 16, 41p6 Permit Issued on Friday, July 8, 2005 I hereby certify that the above information is correct and that the construction on the above described property and the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington iand the City of Federal Way. Owner or agent:/ y 4. Date: /07/1 k (i° f City of Federal Way Certificate of Occupancy This Certificate issued pursuant to the requirements of Section 110.2 of the International Building Code certifying that at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. This certificate is valid ONLY when endorsed by City staff. Tenant Name: ODEYCHUK Permit#: 05-100731-00-SF Address: 30502 24TH AVE SW Includes: #1 #2 #3 #4 Occupancy Class: R-3 U Construction Type: Ty•- V-B Type V-B Occupancy Load: Floor Area(sq.ft.) 1 / 0 0 Owner Name: VIKTO O DEYCH VIKTOR EYCHUK Owner Name: VICTORI N CONSTRUCTION Owner Address: .823 PIC IC POINT RD ,� I :DMOND WA 98026 i T:\\\ ..._} MX. � " , CBCT -' .Z. / 71, *3/06 Building Official 03A bate The priority focus in the rev: and inspection m:de by the City prior to issuance of this Certificate was on those matters which experience has shown most se,- I affect the h:alth and safety of the general public. Although the City has made as complete a review and inspection as is reasona• •.ssib (within budgetary time and personnel limitations), the City neither guarantees nor warrants to the owner/occupant or to any other person that this Certificate evidences strict compliance with each and every ordinance or regulation of the City or the State of Washington affecting the construction or use of said structure or the land upon which it is situated. Such compliance is the responsibility of the owner and/or occupant of the premises. // r • City ofFederal pmentWay Building - Sin le FamilyPerm#• 05-100731 -00-SF Community Development Services g P.O.Box 9718 Federal Way,WA 98063-9718 Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253) 835-3050 ' ! , Project Name: ODEYCHUK ! LF riarate Project Address: 30502 24TH AVE SW Parcel Number: 889420 0050 Project Description: NEW-Construct a new 3409sqft,2-story residence with a 874 sqft attached garage and 46 sqft deck,including plumbing& mechanical. ****4 bedroom; $600,000**** 10/17/06 Add 210 sf to deck area** +++10/18/06-Additional bedroom & bathroom on 2nd floor+++ Owner Applicant Contractor Lender VIKTOR ODEYCHUK VIKTOR ODEYCHUK VICTORIAN CONSTRUCTION PRIVATE LENDERS GROUP VICTORIAN CONSTRUCTION VICTORIAN CONSTRUCTION VICTOC*032DJ 03/11/06 411 108TH AVE NE SUITE 520 6823 PICNIC POINT RD 6823 PICNIC POINT RD 6823 PICNIC POINT RD BELLEVUE WA 98004 EDMONDS WA 98026 EDMONDS WA 98026 EDMONDS WA 98026 Census Category: 101 - New single family house, detached Includes: #1 #2 #3 #4 Occupancy Class: R4 U Construction Type: Type V-B Type V-B Occupancy Load: Floor Area(sq. ft.) 0 0 0 0 Additional Permit Information New/Additional Sq.Feet- 1st Floor 1506 New/Additional Sq.Feet-2nd Floor 1903 New/Additional Sq.Feet-Other 0 Plumbing to be Included? Yes i New/Additional Sq.Feet-Total 4539 Zoning Designation RS 7.2 New/Additional Sq.Feet-Basement 0 Basic Plan? 16:.).,..1:•t"..? ..tri 416 Occupancy#2-Construction Type Type V-B New/Additional Sq.Feet-Deck 256 Fire Dept.Access/Hydrant Loc.Needed? No New/Additional Sq.Feet-Garage 874 Height of Structure 25.5 Mechanical to be Included? Yes Occupancy#1 -Class R-3 Occupancy#2-Class U Mechanical Fixtures Ducts 1 Fans 6 Furnaces 1 Gas Logs 2 Ranges 1 Gas Pipe Outlets 7 Hot Water Tank 1 Plumbing Fixtures Bathtubs 3 Dishwashers 1 Laundry Washer Outlets 1 Lavatories 6 Showers 3 Sinks 2 Water Closets 4 Hose Bibbs 2 CONDITIONS: * Right of Way Permit Required For Install of Driveway Approach and Possible Relocation of Wheel Chair Ramp,Street Tree& Sign. Contact Public Works Department 253-835-2725. PMIT EXPIRES Sunday, April 16, 116 ermit Issued on Friday, July 8, 2005 I hereby certify that the above information is correct and that the construction on the above described property and the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington and the City of Federal Way. Owner or agent: %�( /Z• llc �% Date: r0 2 e , City of Federal Way Certificate of Occupancy This Certificate issued pursuant to the requirements of Section 110.2 of the International Building Code certifying that at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. This certificate is valid ONLY when endorsed by City staff. Tenant Name: ODEYCHUK Permit#: 05-100731-00-SF Address: 30502 24TH AVE SW Includes: #1 #2 #3 #4 Occupancy Class: R-3 U Construction Type: Type V-B Type V-B Occupancy Load: Floor Area(sq. ft.) 0 0 0 0 Owner Name: VIKTOR ODEYCHUK VIKTOR ODEYCHUK Owner Name: VICTORIAN CONSTRUCTION Owner Address: 6823 PICNIC POINT RD EDMONDS WA 98026 MK. )144644t1 C80 l0/23/`' Building Official ✓ Date The priority focus in the review and inspection made by the City prior to issuance of this Certificate was on those matters which experience has shown most severly affect the health and safety of the general public. Although the City has made as complete a review and inspection as is reasonably possible (within budgetary time and personnel limitations), the City neither guarantees nor warrants to the owner/occupant or to any other person that this Certificate evidences strict compliance with each and every ordinance or regulation of the City or the State of Washington affecting the construction or use of said structure or the land upon which it is situated. Such compliance is the responsibility of the owner and/or occupant of the premises. • • DATE INSPECTOR AICA AND TYPE OF INSPECTION X77/ .0c,�, O�,(/ i2i1/t7 O." - `Q- v 4."C- /- -7),07A/67 70/5 Tom ' Aliiii, ,• THIS CARD IS I'O•MAIN ON-SITE CITY OF 3`communit ' 1fvelo ment Inspection Record P P Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT #: 05-100731-00-SF Owner: VIKTOR ODEYCHUK Address: 30502 24TH AVE SW FEDERAL WAY, WA 98023 This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card. 0 Temp.Erosion Control(4365) 0 Footings/Setback(4110) 0 Foundation Wall(4115) To be done prior to breaking ground_ Approved to place concrete Approved to place concrete • � By S Date 7'/y- O5 By Date 7(4 4,7::', C By Date-7-/ ,. V - 111 • • , ❑ Drainage/Downspout(4040) ❑ Plumbing Groundwork(4190) ❑ Slab/Concrete Floor(4255) Approved to backfill Approved to cover Approved to place concrete •By ti., Date 5'24 .Q e By Date By Date ❑ Underfloor Framing(4285) �❑ Floor Sheathing (4105) [1::: Shear Walls (4245) Approved to sheath floor Approved to install flooring Approved to install siding iBy e.. G,..) Dat •Z7.t 5 By 1 Date g ©S Q Date 1^ () - e El Roof Sheathing(4220) ,❑ Rough Plumbing(4230) ❑ Mechanical Rough-in (4165) Approved to install roofing Approved Approved AtO By c W Date 8-/ 7.,0s' By Date Z3 Gtr" 14 " Date 0- ❑ Gas Piping(4125) °' ❑ Fire/Draft Stops (4095) NOTE: Prior to scheduling a Framing(4120) Approved to release test Approved inspection;Electrical,Plumbing&Mechanical Rough-in and Fire/Draft Stop inspections must be By Date By �' Date(C) 4 signed-off and approved. IBC 109.3.4/UBC 108.5.4 • ❑ Framing (4120) �❑ Insulation (4150) �❑Gypsum Wallboard Nailing(4130) A roved to insulate Approved to install wallboard Approved to install mud&tape By G Date/o_.3....03';,ByC.(A) Date/0 -7.0... By G Co) Date/0 . /g.Q 4.-. El Final-SWM(4375) �� Final-Mechanical(4065) ❑ Final-Plumbing(4075) Approved Approved Approved By Cm Date /e2 /(/ dt, By \ Date 1'''\:\_ i\ t. By C Date f p-• /4_j__"o �-�),, ❑ Final-Building(4050) ❑Temp. Erosion Maintenance(4370) Approved Approved By 17.--7CDate �C����� By Date PEWIT EXPIRES Sunday, April 16, 2. • illtrmit Issued on Friday, July 8, 2005 I hereby certify that the above information is correct and that the construction on the above described property and the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington and the City of Federal Way. Owner or agent: det- (A4p (,fit• 4(0-' Date: t0 2 r ©b City of Federal Way Certificate of Occupancy This Certificate issued pursuant to the requirements of Section 110.2 of the International Building Code certifying that at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. This certificate is valid ONLY when endorsed by City staff. Tenant Name: ODEYCHUK Permit#: 05-100731-00-SF Address: 30502 24TH AVE SW Includes: #1 #2 #3 #4 Occupancy Class: R-3 lJ Construction Type: Type V-B Type V-B Occupancy Load: Floor Area(sq. ft.) 0 0 0 0 Owner Name: VIKTOR ODEYCHUK VIKTOR ODEYCHUK Owner Name: VICTORIAN CONSTRUCTION Owner Address: 6823 PICNIC POINT RD EDMONDS WA 98026 rtidomiewt C80 ,gy" fz-f- /a/23/06, 1(23/9C Building Official Date The priority focus in the review and inspection made by the City prior to issuance of this Certificate was on those matters which experience has shown most severly affect the health and safety of the general public. Although the City has made as complete a review and inspection as is reasonably possible (within budgetary time and personnel limitations), the City neither guarantees nor warrants to the owner/occupant or to any other person that this Certificate evidences strict compliance with each and every ordinance or regulation of the City or the State of Washington affecting the construction or use of said structure or the land upon which it is situated. Such compliance is the responsibility of the owner and/or occupant of the premises. J 4,. ....%...... ITtc , 2 ' ---_ J z2--D 7 3 j ..0 CITY*to. ii) cetera!Way JUL D 8 ,,, PERMIT A-- COMMUNrYDEVELOPMENTSERYifl,.. X0(7 / SSF MF CO ME EL PL DE EN FP 33325 8*"AVENUE SOUTH•POBOX 97�$ ��C�d P P L I C AT I O N TD o cps - The WAY,WA 98063-9718 LdU V^ '1 _ 253-835-2607•FAX 253-835-2609 2 unvw.citgo((ederalwaq.com E.p'• 7 The oliowin• is re•uired in ormation-an incom•lete a••lication will not be acce•ted. Please •rint le.ibi (in in or . Tyy • PROPERTY INFORMATION SITE ADDRESS oJn� i `7 Ave L-2-1), FedeinD / 16)4 q a S UITE/UNIT# — ASSESSOR'S TAX PARCEL# 2 9: Lt 7 0 - 0 V 0 LOT SIZE (s� Cii 7733/ LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) /-01 # S Venin,a_j (Attach separate page for lengthy legal description) • PROJECT INFORMATION TYPE OF PERMIT S,BUILDING p.PLUMBING „MECHANICAL ❑ DEMOLITION cELECTRICAL D ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit only) A'eIL) eo/UsTRueT,©N l SFR VPROJECT NAME(Name of Business or Owner Last Name) /(1 l rlt2 N CO ;��z/e�70/(1 ' a/Cie/C I1[Q/� ` • PEOPLE INFORMATION PROPERTY NAME 1 /`�, e . �/ PRIMARY/ PHONE 7 OWNER , r Oc/ e.. lam-(K (`T 5) /a / - /60.4- MAILING ADDRESS CITY,STATE,ZIP (_,,N(_,,N3 PisC-11 i c Po(U ni Rd. Ednic n da , wit 9eP6026-, CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE Vl CICI R iCUU CONST RUCTrWN V1k1vr Ode e/u/k ( /,'-5-) T17 - /6 EU-MAILING ADDRESS CITY,STATE,ZIP �/ CELL PHONE 6erd3 Picnic Po('rd /d, Ednu}ncd1, uc.)/9 'P00,24 ( --) /7/ - /4'8.2.. CITYc� OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX/NUMBER 7fL p c�C �i�- (� 5 - L� 1GC-- B L /� / 3! 16J (7071) yc - 3 &o CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE VICTOC "* 1302 ,DT -3I // I66 APPLICANT MMPANY NAMEAPPLICANT NAME OFFICE PHONE C-'/OR'itR/'0 N CONS TRU 07/6/1, I/`i,d - 04'CAI/ld (143) V 7 - /b ow, MAILING ADDRESS CITY,STATE,ZIP J. CELL PHONE 64,13 Pier?/'c Po/ �! Ec4nioi')i tj, t)4 feio24, ( .15) 1/71 - /d'cpa• RELATIONSHIP TO PROJECT FAX NUMBER 0 Architect 0 Tenant 0 Agent 0 Other(Describe) (95) 7L/5 - (301(f0 CONTACTPRIMARY PHONE E-MAI ADDRES P; IP r r� Lif d,n,/c, ('/ S) 7? ? - /6 D Vic c. oll-ma//.u,,I LENDER Per RCW 19.27.095: Lender information is NA E required if project value exceeds$5,000 LG M`;LING ADDRESS CITY,STATE,ZIP q 1I I ISP'ME MG #- 5'2,0 136dev�te r1 t 4 l tO )ti • DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO WATER SERVICE PROVIDER n LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL) iSEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE o PRIVATE(SEPTIC) PROJECT FLOOR AREAS . AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ. FT. SQ. FT. SQ. FT. BASEMENT FIRST B, /r -x'06 s f //// CD 64f: SECOND 0 /q03 ..S f // -/0 3 se THIRD _ lifit FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) e j/7/ S f C.�‘s' GARAGE X CARPORT❑ er 279 `^ <7/1sf EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF NUMBER OF FLOORS �j L /3 ovi S f l+ -5o�q sf. **NEW HOMES ONLY** NUMBER OF BEDROOMS T ESTIMATED SELLING PRICE $ 6OO,D Oa e AD FIXTURES Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. MECHANICAL n Value of Mechanical Work $ 8 MO• n yy AIR HANDLING UNITS EVAPORATIVE COOLERS q'o GAS LOGS REFRIG.SYSTEMS — BBQS 5 FANS HOODS(commercial) WOODSTOVES - BOILERS FIREPLACE INSERTS / RANGES — MISC(Describe) "— COMPRESSORS FURNACES / GAS WATER HEATERS / DUCTS GAS PIPE OUTLETS PLUMBING 02+ BATHTUBS(or Tub/Shower Combo) / SHOWERS 3 WATER CLOSETS(Toilet) MISC(Describe) r/7 DISHWASHERS / SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST / WASHING MACHINES URINALS oL HOSE BIBBS S LAVS(Bathroom Sinks) `-. VACUUM BREAKERS --' ELECTRIC WATER HEATERS DISCLAIMER/SIGNATURE BLOCK I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I am authorized by the owner of the above premises to perform the work for which the permit application is made. I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred in the investigation and defense of such claim), which may be made by any person,including the undersigned, and filed against the City of Federal Way,but only where such claim arises out of the reliance of the city�'nclruding its officers and employees,upon the accuracy of the information supplied to the city as a part of this application. NAME/TITLE !V DATE (Signature (Title) RELATIONSHIP TO PROJECT Owner 0 Agent 0 Contractor 0 Architect 0 Other FOR OFFICE USE ONLY o NEW ❑ADDITION ❑ALTERATION o REPAIR ❑TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? ❑YES 0 NO ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? ❑YES o NO PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? ❑YES o NO Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application