650282.pdfApplicant Fill
7,nsldc
PLAN FILE NUMBER
BUILDING
PERMIT 650-282
Building Permit ApplicaMon Heavy Lines
NUMBER
NAME (OR NAME OF BUSINESS)
JOB ADDRESS
S-�C_vi i�J—
Z
MAILING ADDRESS
SIDE YARD
SET BACK REAR YARD
4
CITY
TELEPHONE NUMBER
USE ZONE
MAP NUMBEH-
VACANT 81
o
NO
[] YES []
,NAME
-E—UILDING AREA
LOT AREA
VARIANCE NUMBER
HEIGHT
NOTE: ALL BUILDING SETBACKS
TO EAVE LINES
TELEPHONE NUMBER
REMARK13
Encroachment Permit PERMIT NUMBER STREET GRADE CHECKI,
Required
Y_ Cl NO
I I
14
TELEPHONE NUMBER
Mi:-fv�r�.5IZE SERVICE SIZE CLEARANCE BY
I
ICRECKED
:LICENSE NUMBET-
CITY LICENSE NUMBER
REMARKS
LOT BLOCK TRACT
L
TYPE CONNECTION VERIFIED BY
1:4
PERC. TEST PERMIT NUMBER
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES No
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
U
YES NO
PLAN CHECKED BY
94
Z
0
WORK TO BE, DONE
NO. Of BUMS.
PERJBLDG.
TOTAL FEE
BUILDING
VALUATION
V2,_57 61-P,
F&DN'T
2
BUILDING PERMIT
FEE
El
NEW
E] DEMOLISH
NUM13ER OF STORIFR
PLUMBING
ADD
3
PERMIT FEE
4
HEAT & GAS LINE
PERMIT FEE
11 ALTER
REPAIR
EE RESIDENTIAL
NON-RESIDENTIAL
NUMBER OF
DWELLING
UNITS
—
5
DEMOLITION
PERMIT FEE
PROPOSED USE
6
AMOUNT DUE
&9�
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 laws regu-
luting construction; and in doing the work authorized thereby, no person
will be employed In violation of the� Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
This application Is not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR
INSPECTION
DEPARTMENT
TY OF
EMIONDS
PR 6-1107
receipt Is acknowledged in space provided,
DIRE TOR'S 8 N URE
7
SIGNATURE (OWNER OR AGEN DATE SIGNED
7� 7/
pL_0T PLAN CHECK & APPROVED
FILE
or
ro
o, to A o.,
p . , 11 1 1 1 . . I . %-