670029.pdf;U LUIMV DEPARIIIIII&NI Applicant FIII
Inside Heavy Lines
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
/V/P 21 Alf 1/'
PE�FHONE NUMBXR
TELEPHONE NUMBER
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Y ITELEPHONE NUMBER
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. . . . . . . P OCR 7 TY LICENSE NUMBER
MBER
J�& -Description of Property (Show Below or Attach Four Copies)
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J11)1, '7 rd'1.4r-e CAI
GAS
NEW RESIDENTIAL El LINE
NON-RESIDENTIAL F-1 SIGN
ADD — M RETAINING
ElDEMOLISH WALL
E] ALTER EXCAVATE PENCE
El OR FILL El ( .......... x .......... Ft.)
_1 PRE -MOVE swim
REPAIR F INSP. El POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
/ I ,
PERMIT
NUMBER 670029
B ADDRESS
-� '3 10 .3 - 7 17 :t- /Z'�
DE YARD SETBACK HTN"T SETBACK
NO.:
Z
USE ZONE
LOT AREA
VACANT SITE
1 1
[3 YES 13 NO
r.,
HEIGHT
I BUILDING AREA
VARIANCE NUMBER
PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W le..V FT. DEFlGjENCY THIS PROPERTY
...
0
COMP. PLAN ST. R/W ............ FT. 'Ovd'%� ...... PT.
REMARKS
0
Z
7D:7�—
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METER SIZE SERVICE SIZE CLEARANCE
BY
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ICHECKED
AEM.ARKS
TYPE CONNECTION
VE lay
7-Elcu. -XZMw
PERM"EJAIR R
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
13 YES E] NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
0 YES 13 NO
PLAN CHECKED BY
T
REMARKS
All construction to comply with the UBC
Valuation
Plan Check No .....................
PROPOSED USE
fi -51 P
BUILDING
PLUMBING
_XLOT PLAN (Indic to Building setbacks, abutting streets)
HEAT & GAS LINE
PENCE
N
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
Ll
PRE.MIOVE INSPECTION
1'�'
EXCAVATION OR FILL
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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-
Ized agent of the owner. I agree to comply with city and state laws regu-
at!ng construction; and in doing the work authorized thereby. no person
h
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th
reg
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0
n
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u
p r
son
wIII be employed In violation of the Labor Code of the State of Washington
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elating to Workmen's Compensation Insurance.
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NOTE: Permit Limit One Year (Except DEMOLITIONS which
a 11 1 - BUILDINGS shall be com-
shall be completed in ninety days; t[OVED-IN
p etc
pleted In six months.)
I I N
SIGNATURE (OVVNER Oft AGENT) �D�ATE 81GNED
(A
NOTE: Applicant Stibject to Plan Check Fee
This Permit covrrs work to be done on private property ONLY.
Any construction on the public d0maln (curbs, oPlewalks, drivewaYff,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
No.
ATTENTION APPLICATION APPROVAL
THIS PER1%IIT This application is not a permit until
AUTHonizEs
ONLY THE signed by the Building Official or his Dep-
WORK NOTED uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
INSPECTION DIRJFXT#R'S SIONATUJ4E
DEPARTMENT
CITY OF DATEw
ED31ONDS
PR 0-1107
FILE
0
Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace & F ines
Final
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