670040.pdf0
POSTED ON KROLL MAP NO.:
BUILDINU
PERMIT
'70040
N-ILDING DEPARTMEN Applicant Flu
,
NUMBER
Inside Heavy Lines
PERMIT APPLICATIONT 7es
JOB ADDR
#TV,
I
Or
Pr W
NAME (OR 14AME OF BUSINESS)
SIDE YARD SETBACK
STREET SETBACK
REAR YARD SETBACIC
USE ZONE
LOT AREA
VACANT SITE
Wz"PHONE NUMBER
K-
HEIGHT
I
BUILDING AREA
�_(Y ES NO
VARIANCE NUMBER
9k
P 11j,APPROVED
REMARKS
TELEPHONE NUMBER
%
REMARKS
MR
METF SIZE SERV IZE CLEARANCE
,R ICE 8
CH ED BY
I TELEPHONE NUMBER
MMARKS
�IACENSE NUMBER
CITY LICENSE NUMBER
TYPE CONNECTION VE E
Y
BY
ascription of Property (Show Below or Attach Four Copies)
PERC. TEST PERMIK�rBER
Z—
��w nw Pnvp�TT �.n�
Fj Mj NEW
A ADD
QALTER
F�
REPAIR
^_Aezu
El I F-1
DEMOLISH I n
SIGN
FENCE I
RESIDENTIAL U
%&BER OF
N LLING
NON-RESIDENTIAL UNITS
I hereby acknowledge that I have read this application; that the In-
formation given In 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 Compensation Insurance.
Demolitions which shall
NOTE: Permif Limit One Year l,'e'c'ol'n'pIetvd In ninety days.)
///Z
N07;e- Applicant Stk4ject to Plait Cherk Fee
This Permit N)v(-m work to lie doue on private pro1wrty ONLY.
Any construction on the public domain (curbs, midewallim, driveways,
marquees, e1c.) will require separnte permlH%lon.
13 YES cl� �o
,48PECTOR REWIRED OCCUPANCY GROUP
YES d4qlo�'
PLAN CHECKED BY
VALUATION TOTAL FEE
BUILDING
I VALUATION
BUILDING PERMIT
2 FEE Ileg, 0
PLUMBING
3 PERMIT FEE
HEAT & GAS LINE
4 PERMIT FEE
SIGN PERMIT
5 FEE
DEMOLITION
6 PERMIT FEE
PLAN CHECK
7 FEE
8 AMOUNT DUE
ATTE NTION APPLICATION APPROVAL
THIS PERIMIT This application is not a permit until
AUTHORIZES signed by the Director of Building Inspec-
ONLY THE
WORK NOTED tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
INSPECTION DIRECTOR'S SIGNATUR
DEPARTMENT
CITY OF
DATE L/
EDBIONDS
I'll 6-1107
FILE
a -
�p I
�p �'Pi
4di
LL