650116.pdf............
Applicant Fill
Building Permit �on
Applicati- inside Heavy Lines
PLAN FILE NUM13ER
BUILDING
PERMIT
NUMBER
6501 1 b*
NAME (OR NAmm or jjuSINESSV-�
JOB ADDRESS
t ( 5�
0 DRESS r.11 5 ,
81DE YARD
SET BACK
REAR 7YARDV:
i LEPHONE NUMBI!!R
y E
IV
USE ZONE
MAP UMBER
ITE
VACANT SITE
0 YES [31 N 0
BUILDING AREA.
LOT AREA
VARIANCE NUM13ER
HEIGHT
NOTE:
AL L BUILDING SETBACKS
TO EAVE LINES
L
Encroachment Permit PERMIT NUMBER STREET GRADE CHECK
Required X
14
ri YES ri NO
TRACT
PERC. TEST PERMT NUMBER
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES No
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
7ZLV [3 NO
0 YES
PLAIT CHECKED BY
4) qL-I-f
WORK TO 14E
f NO. OF BLOGS. FEMBLOO. TOTAL FICK
z
BUILDING 0
VALUATION
BUILDING PERMIT
NUMBER OF STO — ES 2 FEE
NEW DEMOLISH — PLUMBING
3 PERMIT F M-
N ADD
HEAT & GAS LINE
ALTER RESIDENTIAL NUMBER OF 4 PERMIT FEE
DWELLING
REPAIR NON-RESIDENTIAL UNITS DEMOLITION
1 5 PERMIT FEE
PROPOSED USE 6 AMOUNT DUE 6
I hereby acknowledge that I have read this application; that the In.
formation given Is correct; and that I am the owner, or the duly author. ATTENTION APPLICATION APPROVAL
Ized agent of the owner. I agree to comply with city and state Iowa rogu- THIS PERMIT This application is not a permit until
latlng construction; and in doing the work authorized thereby, no person AUTHORIZES
will be employed In violation of the Labor Code of the State of Washington ONLY THE signed by the Director of Building Inspec-
relating to Workmen's Compensation Insurance. WORK NOTED tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR receipt is acknowledged in space provided.
INSPECTION
13IGNATURE (OWNER OR AGENT) DATE IGNED DIRECTOR'S SIGNAT7E
DEPARTMENT
CITY OF T
EDIVIONDS DA ..... . .......
PLOT PLAN CHECK & APPROVED
I PR 6.1107
FILE