640250.pdfBuilding
Applicant FIR
Lines
Permit A licationi !T
PP
PLAN FILE NUMBER
"LAN
BUILDING
PERMIT 640250
NUMBER
Inside
Hea
NAM (01� ,PAME OF -BUSINESS)
JOB ADDRESS
B
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!�ILLN G JXDDRESS
SIDE _�Ar
SET BACK REAR YARD
71—
101
4
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Num,
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USK-ZONE
qMBE
17 /�Z� R:3
VACANT SITE
0 YES [3 NO
,NAMID
A WROESS
CITY TELEPHONE NUMBER
MAN
I
a
BUILDING AREA LOT AREA VARIANCE NUMBER
H 'IGHT K
E, ALL BUILDING SETBAC 8
I NOTE: TO EAVE LINES
Required
rl YES M NO
0 YES [j NO
[] YES [3 NO
NO. OF BLD08. PERIBLOG. TOTAL F99
BUILDING
VALUATION
2
BUILDING PERMIT
FEE
Q
0
NUMBER OF STORIES
PLUMBING
NEW
DEMOLISH
3
PERMIT FEE
El ADD
—
HEAT & GAS LINE
PERMIT FEE
4
ALTER
RESIDENTIAL
NU ROF
D%EBLEING
UNITS
DEMOLITION
REPAIR
NON-RESIDENTIAL
5
PERMIT FEE
PRO78ED USE
- / /
/ V, �///
6
AMOUNT DUE
e—W
/0
/ /<
I hereby acknowledge that I have read this application; that the In-
ATTENTION
APPLICATION APPROVAL
formation given In correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws regu-
THIS PERMIT
This application is not a permit until
lating construction; and In doing the work authorized thereby, no person
AUTHORIZES
signed by the Director of Building Inspec-
will be employed In violation of the Labor Code of the State of Washington
ONLY TILE
relating to Workmen's Compensation Insurance.
JVORX NOTED
tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR
receipt is acknowledged in space provided.
S
;IGNA URE (OWNER OR AGENT) DATE 8 GNED
INSPECTION
DIRECT GNATURE
DEPARTMENT
4<1
CITY OF
DATE
�xyr P APPROVED
ED51ONDS
7, 777',
PR 6-1107
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