670549.pdfPOSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant FM NUMBER 670549
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
NAME (OR NAME OF BUSINESS) 44 0 0 N-
SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK
J-46 Ed T 7-
G ADDRESS
7
TELEPHONE NUMBER
T
ELEPHONS NUUBOF
V�)
TELEPHONE NUMBER
CITY LICENSE NUALISNIt
(Show Below or Attach Four CoPICflT_
GAS
El RESIDENTIAL LINE
1:1 NON-nESIDENTIAL F� SIrr;
R RETAINING
ElDEMOLISH WALL
DALTER EXCAVATE PENCE
F OR FILL ( .......... x .......... Ft.)
REPAIR PRE -MOVE SWIM
R INSP. 0 POOL
DWELLING
UNITS
t
N
I
I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I ant the owner, or the duly author-
lzed 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 six months.)
IIGNNTURE (OWN4 C Oft AGENT) DAWN lu�z�
<::� "I I I
NOTE: Appl,icitnt Snbject to Plan Check Fee
USE ZONE
LOT AIWA
VACANT SITE
z
1
1
[3 YES [3 NO
a,
HEIGHT
BUILDING AREA
VARIANCE NUMBER
FLUF -PIA-4APPROVED
STREET RIW
EN38TING STREET R/W ............ FT.
DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ Fr.
............
14
REMARKS
CHECKED BY
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
I
REMARKS
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
[:I YES NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
YES N
PLAN CHECKED BY
REMARKS
No.
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE &13 7
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES
ONLY THE signed by the Building Official or his Dep-
WORK NOTED uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
INSPECTION DIPFC R SIGN T
DEPARTMENT
CITY 01 DATE
ED31ONDS 0-I
Pn 0-1107 �k
This Permit coverff'work to be done on private property ONTX.
Any construction on the public domain (curbs. sidewalks, driveways, FILE
marquees, etc.) will require separate perralmalon, I
, M