680289.pdfPOSTED ON KROLL MAP NO.: PERMI
Applicant FM / :) 0 NUMBER
BUILDING DEPARTMENT Inside Heavy Lines 680289
PERMIT APPLICATION
JOB ADDRESS
NAM (OR NAME OF BUSINESS)
/9/)Zf — 93 0j
SIDE YARD SETBACK STREET SETBACK REAR Y D 1119'I'MAUX
M R
ILING ADDRESS
W ' �25
H I> 1001Y. t4l, TIRE VONE LOT AREA vAvANW BIT19
CITY TELEPHONE NUMBEF-- 1 0 TEO NO
Q� 1> I --;i. I �?
fa HEI T I BUILDING AREA VARIANCE
NAME -3o MA.41 I I
PLOT PLAN APPRqVED
ADDRESS
STI ZET R/W
CITY TELEPHONE NUMBER EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ..... 16 i
NAME REMARKS
Driveway slopes not__�to exceed those
ADDRESS indicated on Standard Drawing #103.
TELEPHONE NUMBER as pc%- CHECKED BY
CITY L
i3o Z_
-S IZPE
STATE LICENSE NUMBER CITY LICENSE NUMBER SERVICE SIZE CLEARANCE BY
I C7— 10,
a) F A —
Legal Description of Property (Show Belov or Attach Four Copies)
TYPE CONNECTION VIWED BY
z
PERC. TEST PE41T NUMBER
Q
Z.-e".ce, NJ- REMARKS In
FIRE ZON TYPE 0 )NSTRUC ON STREET IMPROVED
I j� U I [] YES 0 No
SPECTOR REQUIRED OCCUPANCY uRoup
RESIDENTIAL GAS 0 YES �?�O
lidNEW Mi LINE PLAN CHECKED BY
I E] NON-RESIDENTIAL SIGN
FRETAINING REMARKS
1:1 DEMOLISH WALL
aAev
ALTER EXCAVATE PENCE
E] OR FILL ( ........ . x . ........ Ft.)
REPAIR PRE -MOVE swim
1:1 INSP. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK
Al C's
Valuation Fee Receipt No.
Plan Check No ............... ....
PROPOSED USE BUILDING
zUsjWs
PLOT PLAN (Indicate Building aetb ks. abutting streets) PLUMBING
14 -E.4) V I,-,
HEAT & GAS LINE
SIGN
RETAINING WALL
SWIMMING POOL
4 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- ATTENT]ION
lating construction; and In doing the work authorized thereby, no person
will be employed to violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY TILE
NOTE: Permit Limit dne Year (Except DE31OMTIONS which WORK NOTED
shall be completed In ninety days: MOVED -IN BUILDINGS shall be corn-
pleted. In six months.)
I
UGNATUR_E�(OFA OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
My or
Mimi EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the publio domain (curbs, sidewalks, driveways,
marquee@, etc.) will require separate permission.
APPLICATION APPROVAL
TWs application Is not a permit until
Signed by tile Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged In space provided.
�arl_
FILE
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