660585.pdfPOSTED ON KROLL MAP NO.; PERMIT
BUILDING DEPARTMENT Applicant Fin NUMBER 66Q58
I_ � 'A
PERMIT APPLICATION Inside Heavy Lines JOB ADORE � A ill I, —
EF ..... .
NA161 (OR NAME OF BUSINESS)
:7e YARD SETBACK It STREET SETBAC REAR YARD SETBACK
SIDE
........... _K
c�7
MAILING ADDRESS 7 VACANT SITE
114 /u, USE ZONE LOT AREA
CITY TELBL'HONE NUMBER 6� 0 NO
HEIGHT 13UILDING AREA VARIANCE NUMBER
19 &1
NAME OVED
PLOT PLA3�,.APP
ADDRES13
STREET R/W
CITY TELEPHONE NUMBER EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ 7T.
REMARKS
NAMM
CHECKED BY
ADDRESS
METE4 SIZE SERVICE SIZE CLEARANCE CHEC BY
CITY TELEPHONE NUMBEMR It
24
RZ=RKS
STATE LICENSE NUMBER CITY LICENSE NUMBER
TYPE CONNECTION VERI;g.D BY
2 2-
Legal Description of Property (Show Below or Attach Four Copies)
PERC. TEST PERMkT\PUMBER
"'o T—
REMARKS
7'
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES 0-110
PLAN CHECKED/BY
GAS
RESID LINE REMARKS
ENTrAL
NEW I El
NON-11 M
SIGN
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
El
PENCE
F1
OR FILL
( .......... x .......... Ft.)
REPAIR
F_]
PRE -MOVE
INSP.
M
SWIM
POOL
DWELLING
UNITS
NATURE OF WORK TO BE DONE
A -ol - i A 1�2 -s�— 15; z /
I hereby acknowledge that I have read this application; that the In-
formation given to 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 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 Compennation. Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; 31OVED-IN BUILDINGS shall be com-
pleted In nix months.)
NOTE.lAppficant S�Kcct to Plan Check Fee
This Permit covers work to be done on I)rlvnte property ONLY.
Any construction on the public domain (curbs, sidewalks, drivinvays,
rnarquees, etc.) will require separate permission.
Valuation
Plan Cheek No.
Fee
BUILDING o
PLUMBING D_
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE-31OVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
V
ATTE, NTION APPLICATION APPROVAL
TIUS PERMIT This application is not a permit until
AUTHORIZES
ONLY TIIIE signed by the Building Official or his Dep-
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION DIRECTOR'S SIGNATURE
DEPARTMENT
CITY OF
DA,TE
EUMONDS
PR 6-1107
FILE
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