650213.pdfMBER BUILDING
PLAN FILE NU
In A1111111 11 PERMIT
Building Permit Application side Hen, Lines INUMBER 650213
NAME (OR NAmifl uk, BUSINESS) JOB ADDRESS
eP&AW 7- - , I-la-5 7_0A/ X2 2 Z P A /`V. 5 REAR YARD
MAILING ADDRE_ SIDE YARD �SE 7 B A 0 K
/40
-ul—TY —MBI!;R MAP NUMBER VACANT SITE
I TELEPHONE NU USE ZONE-1 0 Y 01
OA/,b -5 0 YES 0140 r.1)
NAME BUILDING AREA. LOT AREA VARIANCE NUM13ER
�Wl
ADDRESS ALL BUILDING SETBACKS
NOTE: TO EKVE LINES
CITY TELEPHUNN AUMK�t
NAM
-ADDRESS -Encroachment Perralt PE NUMBER STREET GRADE CHECK 0
Required
rl YES [71 NO
CITY TN�r�ONE NUMBER METER SIZE I SERVICE SIZE CLEARANCE CHECKED BY
Q STATE LICENSE NUMBER CITY MCED113E NUUMBER RKs
LOT BLOCK TRACT
TYPE CONNECTION VERIFIED BY
PERC. TEST PERMIT RUMBER
-IRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES 13 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES NO
PLAN CHECKED J3X
WORK TO BE DONE NO. Or BLOOD. PERIBLOG. TOIAL FKX
BUILDING
VALUATION
-C2 BUILDING PERMIT
NUMBER OF STORIE 2 FEE
F] NEW DEMOLISH PLUMBING
3 PERMIT FEE
ADD BEAT & GAS LINE
RESIDEN'
F-I ALTER riAL NUMBER OF 4 PERMIT FEE
DWELLING DEMOLITION
REPAIR NON-RESI UNITS 5 PERMIT FEE
AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In
formation given in correct; and that I am the owner, or the duly auth� ATTENTION APPLICATION APPROVAL
Ized agent of the owner. I agree to comply with city and state lawn regu- THIS PER311T This application Is not a pern-Lit 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 THE
tion, or his deputy; and fees are paid, and
relating to WorlaneWs Compensation Insurance. WORK NOTED receipt Is acknowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR INSPECTION
SIGNATjRE (OWNER OR AGENT) NED DIRECTOR'S SIGNATURE
ATE 81
DEPARTMENT
CATY OF
I)MONDS
PLOT PLAN CHECK & APPROVED .77
PR 6-1107
_77
FILE