660274.pdfPOSTED ON KROLL MAP NO.:
BUILDING
PERMIT
660274
BUILDING DEPARTMENT Applicant Fill
NUMBER
Inside Heavy Lines jOB ADDRESS
PERMIT APPLICATION
0
NAME (OR NAME OF BUSINESS)
Z72 �2 00
SETBACK REAR YARD SETBACK
Jay Peterson
SIDE YARD SETBAC1111Z STREET
No ADDRESS
W.
i ]&� '13rrE
USE ZONE
7627 200th
CITY TELEPHONE NUMBER
0 YES NO 0
rrr.111al-nonas) Wash. PR 6-1901
HEIGHT BUILDING AREA VA�RIANCE NUMBER
NAME
PTor PLAN APPROVED
..
....
ADDRESS
REMARKS
CITY
Seattle Gas 3ervice,, inc.
REMARKS
04 ADDRESS
6,-01 i�oosevelt [a Y
IZE SERVICE SIZE _[dLEARANCE �CKED By
UI-T—y
NUMBER
Deattule� Washinct
'�900
n LA 3-(
STATE LICENSE NUMBER
I LICENSE NUMBER
TYPE CONNECTION
BY
Legal Description of Property (8h;w Below or Attach Four Copies)
PERO. TEST
PERMIT NUMBER
US
0
S
FIRE ZON E OF CONSTRUCTION STREET IMPROVED
:ET IMPROV:1D
YES [3 NO
SPECIAL INSPECTOR REQUAIIZV
0
CCUPANCY GROUP
0 YES 0 NO
F
PLAN CHECKED By
VALUA SON TOTAL FIEK
B ING
WORK TO BE DONE
1 VALUATION
ii�w Gas Furnace and �Jater Heater
BUILDING PERMIT
2 FEE
PLUMBING
3 PERMIT FEE
Z
HEAT & GAS LINE
4,00
4 PERMIT FEE
NEW 811 N
NUMBER OF STOIRUIES
SIGN PERMIT
ADD DEMOLISH FEr 'JIM
El
5 FEE:
DEMOLITION
ALTER RESIDENTIAL
NUMBER OF
6 PERMIT FEE
REPAIR NON-RESIDENTIAL
DWELLING
UNITS
P CHECK
7 FEE
-FR-01
4. 0 0
8 AMOUNT DUE
I hereby acitnowledgo that I have read this application; that the in-
ATTENTION
APPLICAT ION 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 state laws rzgU-
THIS PERMT
This application is not a permit until
lating construction; and in doing the work authorized thereby, no person
AUTHORIZES
signed y the Director of Building Inspec-
will be employed In violation of the Labor Code Of the State of Was hington
ONLY THE
,
tion, or" his deputy; and fees are paid, and
relnUng to Workmen'll Compensation Insurance.
WORK NOTED
receipt is acknowledged in space provided.
(Except Demolitions which shall
NOTE: Permit Limit one Year be completed in ninety days.)
SIONAT M (OWNER OR AuNrrr) DATE SIGNED
INSPECTION
DEPARTMENT
A
.17
OF
CITY
DATE
EDIVIONIDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Pern'dt covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
FILE
marquees. etc.) will require separate 11VIT011151011-
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