670175.pdfA6 f
Ell POSTED ON KROLL MAP NO.t PERMIT
T Applicant Fill NUMBER 6_701755
BUILDING DEPARTMEN Inside Heavy Lines JOB ADDRESS
PERMIT APPLICATION
NA3MME_( NAMN OF IJUH Be) I I PLOT PLA 7
BIDE YARD SETBACK BTREET SETBACK REAR YARD SET5AQX
�F /,S—
MAILI, _7 ADPRESS LOW VACANT RJITZ
Z4 USE ZO+E AREA
7 e/ 0 Z_ � IV —;r
0 TELEPHONE 14UMLSMK [3 YES
CITY 4�� PS-- TA
j,,�t, _1pRc-_ q�7d HEIGHT BUILDING AMA VAR NCN NUMBER 96
NAME V- 7
:�_e
I
CIBMNG STREET R/W ............ FT -
COMP. PLAN ST. R/W ............ Fr.
REMARKS
FIRE ZONE
TYPE OF
All
A,
SPECIAL INSPE;O,��
[3 YES
No
PLAN CH 0
BY
rui
NEW RESIDENTIAL F
GAS
LINE
RE 8
NON-RESIDENTIAL
SIGN
ADD
DEMOLISH
rAINING
WALL
ALTER EXCAVATE
OR FILL
PENCE
( x Ft.)
.......... ..........
PRE -MOVE
REPAIR INSP.
SWIM
POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
Plan Check NO ............ . .......
PROPOSED USE
BUILDING
�tbacks,
P LOT PLAN (In iAft abutting streets)
PLUN=NG
A
HEAT & GAS LINE
FENCE
44 6C 9
t SIGN
C3
C3
N
NJ
RETAINING WALL
SAO BVI&PIya
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
io
EXCAVATION OR FILL
2- Q Z
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given to correct: and that I nun 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 WaAhlngtOn
rolaUng to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except I)EMOLITIONS which
shall be completed in ninety days; l%lOVED-IN BUILDINGS shall be 00m.
plated In six months.)
-ITI—ONATURE (OWNER Olt AU�Nl') or —
NOTE: Applicant Subject to Plait Check Fee
This Pernilt covers work to be done on Private property ONLY.
Any construction on the public domaln (curbs. sidewalks, driveways,
n=rquoas, etc.) will require separate permission.
ATMNTION
Ting PER311T
AUTHORIZES
ONLY THE
IVORK NOTED
INSPECTION
DEPARTMENT
CITY OF
jV1Xy1T1W11"�
PR 6-1107
DEFICIENCY THIS PROPERTY
Valuation
[] YES
Fee
L
Z
No.
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Off Icial or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
FILE