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19919 80TH AVE W
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POSTED ON, AltAVLL MAP NO... PERMIT
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PERMIT 4P OtATION
Inside Heavy
ADDRES8
NAME (OR NAME OF BUBINE
Slull�' YARIJ SETBACK
ST EET SETBACK
ItEAR YARD SiTBACZ
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RAILING A.DDREdS
P7
MIN
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USE ZONE
LOT AR.EA
SITE
TELEPHONE NUM
0 TE13 0 NO'
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'JiLDIN
NUMBER
HEIGHT
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NAME
ADDRESS
8TRZET R/w
THIS PROPERTY
CITY
TELEPHONE NUMB
EXISTING ST ELT R/W FT. DEFICMICY
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COMP PLAN ST R/W FT ............ 1"T.
NAME
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I CRE--XED By
A-DDRE&S
METER SIZE
SERVICE SIZE
CLEARANCE
CHECKED By
CITY TELEPHONE NUMBER
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REMA
CITY L";
STATE LICENSE NUMBER Cl LICENSE NU ER
TYPE CONNECTION
VERIFIED BY
LcUal De.cription of Property (8how. Beluw or Attach Four Coot,.)
P)111C. TEST'
PERMIT NUMBER
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'76
F
N 9 A/ Z q�-
FIRM ZONE TYPE OF CONSTRUCTION STRE-11T IMPRRVED
0 -rES C) r;o
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SPECIAL INsrxcToR REQUIRED
OOCUPAN17Y GROUP
[3 YE6 C] No
BY
R
GAS
LINE
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0 NEW
"MAA"
N
El
ADD
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DEMOIaSH
DALTER E]' EXCAVATE E].FENCE
OR FILL C. I Ft
PRE.1 OVE
INSP., El aw"
REPAIR Pool,
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it or
1XIVELLING
UNITS
NATUFF OF W014LX TO BE DONE
Viiiiintion
Fee
Rceelpt
170..
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Cd
PROPOSED USE
BUILDING
0
0
PLUIMING
-Building s,tbac k,
PLOT PLAN (Indlcat� abutting rtmets)
HEAT & GAS LINTE.
PENCE
N
RFTAiNlN16 WALL
SWIMMING POO L.
r
DEMOLITION
PP.F.I.16VE INSPECTION
EXCAVATION on PILL
TOTAL AMOUNT DUE
I h1rebY acknowledge that I have .ad thin P;11-ti..: that the I. -
formation given in correct: and that I an, the Owrier, c� the duly authc�
Ized agent of mo owner. I agree to comply with eltj ind State 1-3 regU-
AWENTION,
APPLICATION APPRdVAL
I&ttng comitruction; &M In dOIDg the work —tborted thereby. — P—O.
will be employed In violation Of t�. Lacor' C-- of the Sint, of Wehl.g,,.
THIS PERMIT
This application is not a permit until
rel.tirt; to Workmen'. C—pen-ti.. Imm—el.
AUTIIORIZ"
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITION" hkh
ONLY THE
iVORIE NOT�VD
lity; and fees are paid, and receipt Is ac-
be completed �n moctir day,: 310VFD-IN' BUILDINGS be com-
knowledged In space provided.
plet'd in Ix monti-)
AGENT) 15ATE —SIONED
INSPECTION-
SIGNATURE
DFPArTMENT.
CITY OF
DATF.;-
EV31ONDS
"bi"t t I" Ck
NOTE: Applicant S Cbe Fee
or.,:�,ty ONLY.
Thl, r—ut co,em week to be privet
AnY 'On'tMetion on the public lorewn .."r F�LE
n—Q.ce., c4e.) �Ijl "'r, o"n'te.1—