660048.pdfPOSTED ON KROLL MAP NO.: BUILDING
I PERMIT
B U I LDINQ> DEPART MENT AppUmnt Fill NUMBER 660048
JOB ADDRESS
Inside Heavy Lines
ION
�V PERMIT 'APPLICAT
USINEBB) �2 c;Z
NAME (OR NLKE
REAR YARD/SETB
ACK
SIDE YARD SETBACK STREET_SE7BACK
MAILING ADDRESS
USE ZONE LOT AREA VACANT 81
YES Co NO
CITY TELEPHONE NUMBER 'HPIGHT VARIANCE NUMBER
7 BUILDING AREA
NABW
PLOT PLAN APPROVED
ADDRESS
REMARKS
CITY TELEPHONE NUMBER
RE161ARKS
R A*DDRESS
L -
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
TELEPHONE NUMBER
REMARKS
STATE LICENSE NUMBER
urrx LICENSE NUMBER
TYPE CONNECTION VERIFIED BY
Legal Descrip Props ow slow or'Attach Four Copies)
PERO. TEST RMT NUMBER
Q
FIRE ZONE TYPE OF CONSTRUCTION
STREET IMPROVED
YES NO
Z
0
W
04
SPECIAL INSPECTOR REQUIRED
E] YES [3 NO
OCCUPANCY GROUP
PLAN CHE CKUD BY
VALUATION
TOTAL FOX
I
BUILDING
VALUATION
—749 400 .
tolrmwl of)
0
0
WORK TO BE DONE
—�7
2
BUILDING PERMIT
FEE
49�
PLUMBING
MIT FEE
4
HEAT & GAS LINE
PERMIT FEE
NEW
ADD
1
E
DEMOLISH
0 SIGN
1 11 FENCE
NUM ER OF STORIES
5
SIGN PERMIT
FEE
—
6
DEMOLITION
PERMIT FEE
ALTER
REPAIR
RESIDENTIAL
NON-RESIDENTrAL
N MBER OF
D ELL
W ING
I UNITS
-'
PLAN CHECK
FEE
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-
ized agent of the owner. I agree to comply with city and state laws regu-
lating 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 Workman's Compensation Insurance.
ll,c,,t Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
12521
NOTE: Applicant Subject to Plan Chcck Fee
Tills Permit covers work to be done on private Property ONLY.
Any construction on the public domain (curb$, sidewalks, driveways,
marquees. etc.) will require separate permission.
81 AMOUNT DUE I I r,. 470
ATTENTION I APPLICATION APPROVAL
THIS PERMIT This application is not a perrnit until
AUTHORIZES signed by the Directr of Building Inspec-
ONLY THE
WORK NOTED tion, or his deputy; and fees are paid, and
I receipt is acknowledged in space provided.
INSPECTION CTOR'S
DEPARTMENT
CITY OF U TE
EDAIONDS
PR 6.1107
FILE
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Frame
Furnace-& Fuel Lines_��A
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