660573.pdf.... .........
BUILDING DEPARTMENT
PERMIT APPLICATION
BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
POSTED ON KROLL MAP NO.:
tE
PERMIT
NUMBER 660573
JUH ADDRESS
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NAME (OR NAME OF BU
SIDE YARD SEUBACK
USE ZONE
STREET SETBACK
T AREA
RE All YARD SETBACK
VACANT BITE
[3 NO
LING ADDRESS
CITY
TZLEPHUNN 14uMBXR
4� ;7
HEIGHT
BUILDING AREA
VARIANCE NUMBER
NAME
PLOT PLAI; APP
'�OVED
C, wz"FHONE N7UMBER
0
STREET BIW
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ Fr, .......... In.
A
REMARKS
NAMID
Z
i
CKED BY
ADDRESS
MET7 SIZ SERVICE SIZE LEARANCE
(jE IC
�r ( --
IC
-Ul—Ty
TELEPHONE NUMBER
STATE LICENSE NUMBER
I CENUE_ NUMBER
TYPE CONNECTION
Legal Description of Property (Show Below or Attach Four Copies)
PERC. TEST
PER ER
ZZ
Z
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
Zzi _JZ7 [j YES 0_14110�
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
YES 0-No
PLAN CHECKED BY
GAS
RESIDENTIAL LINE
NEW
NON-RESIDENTIAL D SIGN
ADD RETAINING
DEMOLISH D WALT
ElALTER EXCAVATE FENCE
F1 OR FILL ( .......... x .......... Ft.)
REMARK
ElREPAIR
0
PRE -MOVE
INSP.
swim
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
Plan Check No .....................
PROPOSED USE
its Buildlng-setbaCks, abutting streets)
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
DE140LITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duty 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
ATTENTION
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; 31OVED-IN BUILDINGS shall be com-
pleted In six months.)
INSPECTION
DEPARTMENT
13IGNATURE '(OWNER OR T)
13ATE SIGNED
CITY OF
EMNIONDS
NOTE: Applicant Sitliject to Plait Check Fee
PR 6-1107
This Permit covers work to w done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways.
nuLrquees, etc.) will require separate permission.
Valuation Fee Receipt No.
Al
2 67
**7
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
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