650214.pdfnjl_ I
PLAN FILM NUMBER
BUIL.IJINU
bW2 14
ion I,. Applicant Fill
Building Permit Appli side Heavy Lines
PERMIT
NUMBER
NAME (OR NAME OF BUBINNSS)
61��e. J0_ 132--1)1
JOBADDRESS
MAILINGADDRESS
SIDE YARD
SET BACK
��Alt
CITY TELEP ONE NUMBNR
USE ZONE
MAP NUMBER
VACANT SITE
Z VV A.) y 4S
1 [] YES 0 NO
NAME
BUILDING AREA
LOT AREA
VARIANCE NUMBER
ADDRESS
HEJGUT
ALL BUILDING SETBACKS
NOTE:
TO EAVE LINES
CITY
TELEPHONE NUMBER
REMARKS
NAME
;4
ADDRESS
Encroachment Permit
PERMIT NUMBER STREET GRADE CHECK
Required
0 NO
11
CITY
TELEF11U14N NUMBER
METER SIZE SERVICE SIZE CLEARANCE CUE BY
I
I
STATE LICENSE NUMBER
CITY LICENSE NUMBER REMARKS
L —
LOT
BLOCK TRACT
TYPE CONNECTION
R
.2 to J�l rl-? I
LVE
-A PERC. TEST
PERMIT ER
J-6 Alf �7.5,�,( 1 �,rl
FIRE; ZONE TYPE OF CONSTRUCTION STREET IMPROVED
w"? ,I, LLJ�5
YES E3 NO
REQUIRED OCCUPANCY GROUP
/G/ lf�
YES Xrl�C
PLAN CHECKED BY
WORK TO BE DONE
NO. OF 13LOGS. PERIBLOO.. TOTAL FEE
BUILDING
1 VALUATION
69
BUILDING PERMI_
2 FEE
NUMBER OF STORIE
ErNEW DEMOLISH
—
PLUMBING
3 PERMIT FEE
ADD
NUMBER OF
HEAT & GAS IANE
4 PERMIT FEE
ALTER RESIDENTIAL
DWELLING
D REPAIR NO: UNITS
DEMOLITION
5 PEj:tMIT FEE
—FR—OPOSED USE
6 AMOUNT DUE
0
I hereby acknowledge that I have read this application; that the In-
ATTENTION
APPLICATION APPROVAL
formation given Is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and stato laws reru-
THIS PERM]IT
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 Caft of the State of Washington
ONLY THE
tion, or his deputy; and fees are paid, and
relating to Workmen?a Compensation Insurance.
WORK NOTED
NOTE: PERMIT LIMIT ONE YEAR
receipt Is acknowledged In space provided.
SIONATURIE; (OWNER Oft ANNT) DATE SIGNED
INSPECTION
DIRECTOR'S SIGNATURE
;7 7z,
DEPARTMENT
-
CITY OF
PLOT P1,J$ CHECk-& APPROVE�D�
EMIONDS
DATE
PH 6-1101
FILE