670054.pdfPOSTED ON KROLL MAP NO.: PERMIT 77UUU�T
BUILDING DEPARTMENT NUMBER
ON Applicant FIR
Inside Heavy Lines JOB ADDRE88
PERMIT APPLICATI
109
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LDDRESS
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SIDE YARD SETBACK STREET SETBAUA FE YARD SETBACK
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VAC SITE
USE ZONE
TELEPHONE NUMBER YES 13 NO
AREA VARIANG111 AUAln� P4
TRA Lb (n L� HEIGHT BUILDING
LOT PLAN APPROVED
..........
STREET R/W
EN38TING STREET R/W . . ........ FT. DEFICIENCY THIS PROPERTY
Uyn kit'n
ITELEPHONE
`743- 0
iw or
NEW
RESIDENTLA
R
GAS
LINE
NON-RESIDI TIAL
SIGN
RETAINING
DEMOLISH
El
WALL
EXCAVATE
PENCE
ALTER
OR FILL
( x Ft.)
REPAIR
PRE -MOVE
INSP.
.......... ..........
SWIM
POOL
TUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
qATURE OF WORK TO BE DONE
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I
13ftsi N
COMP. PLAN ST. R/W ............ FT- .........
WE -MARKS
CKED BY
FIRE ZONE I TYPE
[] YES [] NO
PLAN CHECKED BY
I Shbw Qr ( Loaf-,P_r wcreie (Relac4ette-
-PYR-OPOSLID USE
Q
PLOT PLAN (Indicate Building setbacks, abutting streets)
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAB LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby ackLiwIedge 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 stato laws rogu-
lattng constructlon; 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 Workmens Compensation Insurance.
ATTENTION
THIS PERMIT
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
INSPECTION
DEPARTMENI�
CITY OF
SIGNATURE (OWNER OR AGENT)
DATE SlGNE
NOTE: Applicant Subject to Plait Check Fee
PR 6.1107
This Permit coven work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate Permission.
I
M
[] YES [] NO
Valuation I Fee I Receint No.
I /,. 67 a 1 3
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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