670301.pdf-- ---------------
BUILDING
DEPARTMENT
Applicant Fill
poSTED ON Hilo" MAP NO.:
PERMIT
NUM13ER
I
670301
PERMITAPPLICATION
Inside Ileavy Lines
:
JOB ADDRESS
NAME (Olt NAME OF BUSINESS)
d- -r2 r, Z a re, - /)
SIDE YARD SETBACK
USE ZONE
Ill REET SETBACK
LOT AREA
REAR YARD SETBACK
VACANT SITE
G ADDRESS
Lle
YES NO
0
CITY
um
M�FHONE NUMBER
, /Z//
HEIGHT
BUILDING AREA
VARIANCE NUMBER
PW
Is
TELEPHONE NUMBER
A3 -
_fE—LEPHONE NUMBER
LICENSE NUMBER CITY LICENSE NUMBE
Legal Description of Property (Show Below or Altaca mour uviieb)
Z
U
W
RESIDENTIAL
GAS
LINE
NEW
1
UN
0
NON-RESIDENTIAL
SIGN
ADD
RDEMOLISH
RETAINING
WALL
ALTER
R
EXCAVATE
OR FILL
PENCE
( x Ft.)
.......... ..........
E:] REPAIR
El
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
teee.)
t
N
I
I hereby acknowledge 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 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 Workman'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 six months.)
VNER OR AGENT)
IIGNA URE (0%
NOTE: Applicant Subject to Plait Check Fee
This rr.mlt covers %vork to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) vrill require separate permission.
EN38TING STREET R/W ............ FT
COUP. PLAN ST. R1W ............ FT
RE- MARKS
OF
[:] YES 0 NO
PLAN CffE—:CKEE> BY
REMARKS
Plan Check No ........
LOWA-03OU0
PLUMBING
BEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
ATTENTION
THIS PERBUT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EMNIONDS
PR 0-1107
DEFICIENCY THIS PROPERTY
[3 YES [] NO
Valuation I Fee
I 5�0-n I
Z
No.
APPLICATION APPROVAL
This application is not a perinit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
0 %
-0. 1 i NeAr, Mm R I i __ W-9 00
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