660224.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
PERMIT 1511% U e_1 (,—I+
NUMBER
JOB ADDRESS
7,1,7 V,
0
6
NAME (OR NAME OF BUSINESS)
r, " i —r/y V kit —1Z,
SIDE YARD SETBACK
STREET SETBACK
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REAR YARD SETBACK
MAILING ADDRESS
USE ZONE
LOT AREA
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VACANT r8ITE
I 0 YES 0 NO
CITY
TELEPHONE NUMBER
HEIGHT
BUILDING AREA
VARIANCE NUMBER
NAME
PLOT PLAN APPROVED
ADDRESS
REMARKS
CITY
TELEPHONE NUMBER
NAVE
REMARKS
ADDRESS
METER SIZE SERVICE SIZE CLEARANCE CHECKED By
CITY
TELEPHONE NUMBER
RELLARKS
STATE LICENSE NUMBER
CITY LICENSE NUMBER
TYPE CONNECTION VERIFIED BY
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Legal Description of Property (Show Below or Attach Four Copies)
W1/20f the SW1/40f SW1/11 of SW
"rERC. TEST I PERMIT NUMBER
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0 of Sec 29 Twnp 27 N Range r EWM Except
S 2561 which incl 301 Road. Except
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NEW
V
E3 SIGN
NUMBER Or STORIES
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2
M
ADD
DEMROSH
I FENC n
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ALTER
RESIDENTIAL
NUMBER OF
REPAIR
10
n NON-RESIDENTIAL
DWELLING
I UNITS
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-
lzed 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.
I1X111L Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
v, N/ ; N4 %I k, , V 1,1- / .3 f
NOTE: (Applicant Subject )o Plan Check Fee
This Pernut covers work to be done tin privnte property ONLY.
Any construction on the public domain (curlifl, sidewalks, drivewnym,
niturquees, etc.) will ri-quIre iteparate permlioilon.
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I= ZONE I TYPE OF
C] YES [] NO
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
BEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
PERMIT FEE
PLAN CHECK
7
FEE
81 AMOUNT
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
ED51ONDS
PR 6-1107
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0 YES [j NO
File.
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APPLICATION APPROVAL
This application Is not a permit Until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt I., acknowledged in space provided.
FILE
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Plumbing (Partiall
(Rough)
Fra me
FurnaceA Fuel Lines
Final
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