640375.pdfApplicant Fill
I'LAN FILE NUMBER BUILDING
PERMIT 640375
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Building Permit Application
I NUMBER
NAME (OR NAME OF BUISLNNUB)
JOB ADDRESS
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MAILING ADDRESS
SIDE YARD
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REAR YARD
CITY
TELEPHONE NUMBER
USE ZONE
MAP NUMBER
VAU�'X MILE
/_�?- 0
[] YES 0
NAME
BUILDING AREA
LOT AREA
VARIANCE NUMBER
ADDRESS
HEIGHT
L UILDING SETBACKS ;61
NOTE: TO EAVE LINES
CITY
TELEPHONE NUMBER
NAM
R
ADDRESS
ncroachment Permit PERMIT NUMBER STREET GRADE CHECK a
Required
YES Q NC
CITY
TELEPHONE NUMB
METER SIZE SERVICE SIZE
CLEARANCE By
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1/.4 - 3, - 0 C�- :;L./
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ICRECKED
STATE LICENSE NUMIJNR
CITY LICENSE NUM33ER
REMARKS
LOT BLOCK TRACT
TYPE CONNECTION VERIFIED BY
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PERO. TEST PERMIT NUMBER
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
-0Z 0/4-1 .,CA
YES Ej ITO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[3 YES NO
PLAN CHECKED BY
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WORK TO BE D E
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NO. OF OLOGS.
PERIBLOO.
TOTAL PIKE
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
NEW
DEMOLISH
NUMBER OF STORIE
—
PLUMBING
3
PERMIT FEE
ADD
HEAT & GAS LINE
ia.ALTER
RESIDENTIAL
NUMBER OF
4
PERMIT FEE
17
NON-RESIDENTIAL
DWELLING
UNITS
DEMOLITION
REPAIR
5
PERMIT FEE
PROPOSED USE
6
AMOUNT DUE
7- 19-C)
I hereby acknowledge that I have read this application; that the in-
ATTENTION
APPLICATION APPROVAL
formation given to correct; and that I am the owner, or the duly author.
ized agent of the owner. I agree to comply with city End state laws regu- THIS PERMIT
This application is not a permit until
lating construction: and in doing the work authorized thereby, no person AUTHORI1ZES
signed by the Director of Building Inspec-
will be employed In violation Of the Labor Code of the State of Washington ONLY THE
relating to Workmen -a Compensation Insurance. WORK NOTED
tion, or his deputy; and fees are paid, and
receipt is aclanowledged In space provided.
NOTE: PERMIT LIMIT ONE YEAR
SIGNATURE �(OWNER OR AGENT) DATESIGNED INSPECTION
DEPARTMENT
DIREC VSI ATURE
=Iyslk
ly, Bldg. Official
CITY 0 F
DAY
— ED51ONDS
PI PROVED
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PR 6-1107
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