670224.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines —j
NAME (OR NAME OF BUSINE1313)
)TED ON KROLL MAP NO.: PERMIT
/C2 el I NUMBER 670224
I ADDRELIS
E YARD SEYrI3AQK STREET SETBACK REAR YARD SETBACK
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MAILING ADDRESS
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SITE
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USE ZONE
LOT�XMREA�rVACANT
YES NO
TELEPHONE I' MBER
PW
HEIGHT
BUILDING AREA
VARIANCE NUMBER
NAME
PLOT PLAN APPR5_V_ED
DDREEIS
iTY TELEPHONE NUMBER
i
STREET R/W
EXISTING STREET n/W ............ FT. DEFICIENCY THIS PROPERTY
�/ 40 ...
COMP. PLAN ST. R/W . FT.
Z
REMARKS
AME
46 leo y
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DDRESS
SO
METER SIZE SERVICE SIZE CLEARANCE
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CHEC#g BY
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ITT
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TELEPHONE NTM—BER
EWMARKS
TATE LICENSE NUMBER
cz 301 !�o P5?
—dI—TYLICENSE NUMBER
TYPE CONNECTION
VERI
Affal Description of Property (Show Below or Attach Four Copies)
PERO. TEST
PERMIT ER
-a C-151 1 (_11 —
19 RESIDENTIA NE
G LB
A
NE�V Ll
I El NON -RESIDE TIAL SIGN
ElADD RETAINING
0 DEMOLISH EJ WALL
E-1 ALTER EXCAVATE PENCE
F� OR FILL ( .......... x .......... Ft.)
REPAIR PRE -MOVE SWIM
INSP. ED POOL
qUMBER OF STORIES NUMBER OF
DWELLING
UNITS
esld�
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES &ITr—
SPECIAL INSPECTOR REQUIRED JOCCUPANCY GROUP
[:] YES 6_%6�
PLAN CHECKED
Plan Check No .....................
PROPOSED USE
BUILDING
PLUMBING
PLOT
PLAN (Indicate Building setbacks, abutting streets)
THEAT
& GAS LINE
PENCE
IJ?
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relaUng to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except I)FI10LITIONS which
ONLY THE
JVORK NOTED
shall be completed In ninety days: 31OVED-IN BUILDINGS shall be com.
pleted in six months.)
_I�DATE
INSPECTION
DEPARTMENT
5IGN RE wNER OR
SlGNED
Ile 2
'FT)
CITY OF
EDITIONDS
NOTE: Applicant Subject to Plait Cbeck Fee
PR 6-1107
This Permit coven work to be dono on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
1 -7, ��t2 0
Fee I Recelpt No.
12e9.15_�o 13111
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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