670139.pdfU.
POSTED ON KROLL MAP NO.: PERMIT
I
NUMBER
6-70139
BUILDING DEPARTMENT
Applicant Fill
�TERFAIT APPLICATION
Inside Heavy Lines
CLOW
joH ADDRESS
042—
'.J �X- A_�
4�1
SIDE YARD SETBACK STREET SETBACK
REAR YARD SETBACK
G A.DDRESS
71.'A- /Y7 N o hi
M
-
1�0 C,
ki
—
USE ZONE LOT A-REA
VA89 SQ
I
—TELEPHONE NUMBEiR
(T )l 17 1
YES 21<0
&GA, k�rv-\ to's
HEIGHT BUILDING AREA
Aw
�NAmin
PLOT PLAN AP VED
STREET R/W
A/'
EXIJITING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
0
TELEPHONE NUMBER
Z
COUP. PLAN ST. R/W ............ FT.
REMARKS
N,
CHECKED BY
Z
ADDRESS
IQ
METER SIZE SERVICE SIZE CLEARANCE
C D BY
CITY
TELEPHONE NUMBOF
C(
REMARKS
STATE LICENSE NUMBER
C LICE NSE NUMBER
TYPE CONNECTION VERIF717
Y
Legaa Description of Property (Show Below or Attach Copies)
-3
PERC. TEST PERMITNV
!2jBER
Z
REMARKS
0
FIRE ZONE TYPE OF CONSTRUCTION
IMPROVED�
ISTREET
0
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[:I YES C3-NO
PLAN CHECKEDBY
0 RESIDENTIAL
GAS
E LINE
D NEW
1
REMARHS
1:1 NON-RESIDENTIAL
SIGN
RETAINING
WALL
DEMOLISH
ALTER EXCAVATE
F� OR FILL
PENCE
( x Ft.)
.......... ..........
REPAIR PRE -MOVE
1:1
swim
El
INSP.
POOL
Es I'TUI
NUMBER OF STORI MBER OF
DWELL
I/ UNITS
cid', 0
Z
PROPOSED USE
C,
PLOT PLAN (Indicate Building met ks, abutting streets)
L!
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-
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.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In sli rati-IIIS.) 11
Vz/,14/6' 7
NOTE: Applicant Subject to Plan Check Fee
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.
Valuation I Fee I Receipt NO.
Pinn Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY TILE
WORK NOTED uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
INSPECTION —DIRECTOR'S SIGNATURE. -
DEPARTMENT
CITY OF _6A . TE
ED31ONDS
PH 6-1107
FILE 1q.r—.