670569.pdfPOSTED ON KROLL MAP NO.: PERMIT
NUMBER 670569
BUILDING DEPARTMENT APPHeant FIR
PERMITAPPLICATION Inside Heavy Lines JOB ADDRESS
NAM (OR NAME OF BUSINESS) A3 g-,.)-9
—[ ISTREET SETBACK HEAR YARD SETBACK
SIDE YARD SE",rBACK
Wj MAILING ADDRESS VAO errs A
—i 4�) USE ' LOT I
110 ZONE AREA
0 YES [3 NO
CITY I r�ntrrrnING ARE
,— 1" 6) HEIGHT 'A VARIANCE NUMBER Ik
NAME
PLOT -PLAN APPROVED
ADDRESS
STREET R1W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
CITY TELEPHONE NUMBER z
COMP. PLAN ST. R/W ............ FT- ............ FT.
REMARKS
NAME
Al
ADDRESS
METER SIZE SERVICE SIZE CLEARA.NCE ICHECKED BY
—CITY UMBER ca
z
REMARKS
STATE LICENSE NUM13ER CITY LICENSE NUMB R
TYPE CONNECTION VERIFIED BY
Legal Description Of Property (Show Below or Attach Four Copies)
049 jC 7- e �o` -4 -U;,*4 1� PERC. TEST PERMIT NUMBER
4?
z
Per, Lr �OA REMARKS
Qw 4o r
CONSTRUCTION STREET IMPROVED
FIRE ZONE TYPE OF
.4 it eex ell I YES NO
SPECIAL INSPECTOR -REQUIRED OCCUPANCY GROUP
[] YES NO
PLAN CHECKED BY
GAS
RESIDENTIA LINE REMARKS
0 NEW I
�NTIAL
ADD NON- - RESIDE SIGN
RETAINING
F-1 WALL
F1 DEMOLISH FENCE
ALTER EXCAVATE Ft.)
F-1 OR FILL
PRE -MOVE SWIM
REPAIR INSP. POOL
r
NUMBER OF
DWELLING
UNITS
NATURE OF WOItK TU 13N VUN�
Valuation Fee Receipt No.
Plan Check No .....................
BUILDING Is-0
6
_iTL_0T PLAN (Indicate Building setbacks, abutting streets) PLUMBING
0 HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWII.IMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
I hereby acknowledge that I have read this application: that the In- 7, sc—
formation given Is correct; and that I am the owner, or the duly author-
11 F A
Ized agent of the owner. I agree to comply with city and state laws regu ATTENTION APPLICATION P%U In
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 PERIMIT This application is not a permit until
rolating to Workman's Compensation Insurance. AUTHORIZES signed by the Building official or his Dep-
ONLY THE
uty; and fees are paid, and receipt is ac-
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed in ninety day$; 31OVED-IN BUILDINGS shall be com- knowledged in space provided.
pleted In six months.) ---
DATE SIGNED INSPECTION DIREC :i, 1[13rjl,,AT 4
ON TU R?� AGE DEPARTMENT
CITY OF
NOTE: Applicant Sitbject to Plan Check Fee EMNIONDS DATE' o_
PR 6.1107
This Permit coven work to be done on private property ONLY.
149
Any construction on the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate permission.