660121.pdfejx
Building
Applicant Fin
Permit Applicationi Inside Heavy Lines
PLAN FILE NUMBER
BUILDING
PERMIT b60 121
NUMBER
NAME (OR NAME OF BUSINESS)
7
JOB ADDRE138 --6 Ctj
Kennard Hoiclal
_C)Z.� -kA�—;30-
MAILING ADDRESS
SIDE YARD
SET BACK
REAR YARD
2005 20th Ave. ;Do,
CITY
TELEPHONE NUMB0F_
USE ZONE
MAP NUMBER
VACANT SITE
-.ridinonds, 1,iash.
PR 157355
E] YES NO
NAME
BUILDING AREA
LOT AREA
VARIANCE NUM13ER
ADDRESS
HEIGHT
L BUILDING SETBACKS
NOTE: TO EAVM LINES
CITY
TELEPHONE NUMBER
REMARKS
NAM
Seattle "Tas Service, Inc.
Z
ADDRESS -
6,,jol iwosevelt ,I_-y 1�. E,
Encroachment Permit PERMIT NUMBER STREET GRADE CHECKI
Required
n YES [3 No I I
METER SIZE I SERVICE SIZE CLEARANCE CHECKED BY
REMARKS
Cs
Z
N
CITY
3eattle, 11.1ash.
TELEPHONE NUMBER
LA 3-8000
STATE LICENSE W—UMBER
UITY —LICENSE NUMBER
LOT BLOCK TRACT
TYPE CONNECTION VERIFIED BY
I
PERC. TEST PERMIT NUMBER
I
FIRE ZONE PE Or CONSTRUCTION STREET IMPROVED
Z
I [] YES E3 NO
SPECIAL INSPECTOR REQUIRED
0 YES [3 NO
OCCUPANCY GROUP
PLAN CHECKED BY
C4
Z
WORK TO BE DONE
Gas Co,.riversion Burner, z1-2-eir,e
NO.OFBLOGS.
PERIBLOG.
TOTAL FEE
BUILDING
VALUATION
uiid '.%later He:�11.ter
21
BUILDING PERMIT
FEE
NEW
El DEMOLISH
NUMBER OF STORIES
PLUMBING
ADD
I —
I
3
PERMIT FEE'
—
4
HEAT & GAS LINE
PERMIT FEE
5.00
F� ALTER
RESIDENTIAL
NUMBER OF
MREPAIR
NON-RESIDENTIAL
DWELLING
UNITS
—
5
DEMOLITION
PERMIT FEE
6
AMOUNT DUE
5.00
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-
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 Workmen's Compensation Insurance.
THIS PER311T
AUTHORIZES
ONLY THE
WORK NOTED
This application Is not a perralt until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR
receipt is acknowledged in Space provided.
INSPECTION
DEPARTMENT
CITY OF
ED31ONDS
SIGNATURE; (OWNER OR AQFNT)
61
DATE SIGNED
OR'S - 81 E
4
/�IATE
V
PLOT PLAN CHECK & APPROVED
FILE
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