660488.pdfI
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BUILDING DEPARTMENT
PERMIT APPLICATION
POSTED ON KROLL MAP 14U.: =UA�",�
PERMIT 660488
D
Applicant flu NUMBER
Inside Hbavy Ilujines JOB ADDRESS %�� 1,q "-A, . - � _�,_
YARD SETBACK STREET SETBACK RffAR'YARD 8
CITY NURM
NAME
ADDRESS
14:9,eo
CITY 1713�FHONE NUE
, _9x_ �1.4 /Pj j
e2�P..2,1 drW ,o -
ADDRESS
OX-5-01-
or
40�11_
HEIGHT
PLOT PLAN PPI
(j YES [3-NO
PLAN CHECKED B
��/ 11X
WORK TO BE DONE
BUILDING
I VALUATION
7—
BUILDING PERMIT
2 FEE
PLUMBING
3 PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
NUMBER OF STORIES
NEW
SIGN
5
SIGN PERMIT
FEE
DEMOLITION
1Z
ADD
DEMOLISH
FENCE
F-1 ALTER
0__�RESIDENTIAL
NUMBER OF
6
—
a
PERMIT FEE
PLAN CHECK
F-1
DWELLING
UNITS
7
REPAIR
NO
FEE
AT
8
AMOUNT DUE
I hereby ackucrwledgo that I have read this application; that th In.
Mor-
ATTENTION
formation given In correct; and that I am the owner, or the duly
Ized agent of the owner. I agree to comply with city and state laws regu-
This rERDUT
lating construction: and In doing the work authorized thereby, no person
AUTHORIZES
will be employed In violation of the Labor Code of the State of Washington
ONLY THE
relating to Workmen's Compensation Insurance.
WORK NOTED
IE,,cepl Demolitions which shall
NOTE: P6rmit Limit One Year be completed in ninety days.)
SIGNATU ER,,�A AGEIN� DATE SIWED
r
14�ww,66
INSPECTION
DEPARTMENT
CITY OF
�APJ)firallt
EDIVIONDS
N07 SIbject to Plan Check Fee
PH 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalk", drivewayg.
marquess, etc.) 'will requirp separate permimplon.
i �
VACANT SITE
0-11�8— [3 NO
VARIANCIG NUMZZ"_
0 YES 11.116,
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 is acknowledged in space provided.
FILE
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