670456.pdf670456
POSTED ON KROLL MAP NO..
PERMIT
BUILDING DEPARTMENT Applicant Fill
NUMBER
es
PERMIT APPLICATIOR. Inside Heavy Lines
JOB ADDRESS
g-c
A." (OR NAME OF BUSINESS)
SIE
13IDE YARD SETBACK
STREET —SETBACK
1
REAR YARD SETBAUN,
I
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1
;2- -,� . t,h t, N
MAILING ADDRESS
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USE ZQNE
I LUT All VjA I
VAUAX17 UK�=
TELEPHONE NfJ
TELEPHONE NUMBER
�z 6<— -7 A-2.
CITY LICENSE NUMBJ01
scriptio ��Show Below or Attach Four Copies)
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1ZNEW
RESIDENTIAL
R
GAS
LINE
NON-RESIDENTIAL
El
SIGN
DRETAINING
'I
F]
WALL
DEMOLISH
ALTER
0
EXCAVATE
PENCE
OR FILL
( .......... x .......... Ft.)
REPAIR
PRE -MOVE
INSP.
swill
POOL
NUMBER OF
DWELLING
UNITS
�A_,T_URE OF WORK TO BE DONE
1 11-11% 1
_00
41
YES 13 NO
VARIANCE 14U R
ow
CISTING STREET R/W -FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W
�'MARKS 1
CHECKED BY
T SIZE I SERVICE SIZE I CLEARANCE CK= BY
[3 YES
Plan Check No .....................
-PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAB-LxNEr'
IIENC13
SIGN
N
RETAINING WALL
h)
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
t,J
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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-
ATTENTION
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
THIS PERMIT
relating to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITION's which
ONLY TILE
WORK NOTED
shall be Completed In ninety days; 31OVED-IN BUILDINGS shall be coM-
pleted in six months.)
U , 07 AGLNTI� DATE SIGNED
INSPECTION
DEPARTMENT
L,j
CITY OF
sesx
ED31ONDS
NOTE: Applicant Subject to Plan Check Fee
Pit 0.1101d
_Yhis —rertnit Covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewmYs,
marquees, etc.) will require separate permission.
[3 YES mlfl�ro
Valuation I Fee
.71
4rl,z,� -.0
(9 4.) , �� IL 0
APPLICATION APPROVAL
This application Is not EL permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
DATE,
q- 2 7
FILE