680291.pdfBUILDING DEPARTMENT
ON Applicant Fill
PERMIT APPLICATI Inside Heavy Lines
680291
POSTED ON KROLL MAP NO.: PERMIT
NUMBER
I
I I
I
—
JOB ADDRESS
NAME (OR NAME OF BUSINESS)
TA4T_1_,E IT
J_
SIDE YARD BET13ACK
STREET SETBACK
REAR YARD SETBACK
0
Z
_.J.6
MAILING ADDRESS
f:9/1 hl
L
USE ZONE
T AREA
1
VACANT SITE
0 YES N
;0
IBE_
KUM
CITY
4,*2,6160 Z) k4,11
TELEPHONE] NUMBJI;R
HEIGHT
BUILDING AREA
VARIAIN40EX R
NAME
PLOT PLAN APPROVED
ADDREBB
STREET R/W
EXISTING STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ........... XT. .......... IT.
CITY
TELEPHONE NUMBER
REMARKS
NAME
ADDRESS
A
CHECKED BY
CITY
wmLErn014E NU�ER
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
Cd
STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMARKS
Legal Description of Property (Show Below oj —Attach Four Copies)
IXJAIIJVI'
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"J15, �� /T�� Al e-=== CA
40w,__4 4 -1 A
—,FY-PE CONNECTION
VERIFIED BY
Z
I
S
PERO. TEST
PERMIT NUMBER
.4=
u Fr. rei
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES [3 NO
7,-9RAi c 4- EA dr7- -7 J��jr— -oc7i 70
yv 11,0s;-Iew / _*__J
SPECIAL INSPECTOR REQUIRED
[] YES NO
OCCUPANCY GROUP
GAS
E] NEW RESIDENTIAL LINE
IJON-RESIDENTIAJ SIGN
DRETAINING
F� DEMOLISH WALL
ALTER EXCAVATE FENCE
F� OR FILL ( .......... x .. ....... Ft.)
PRE -MOVE SWIM
REPAIR INSP. POOL
PLAN CHECKED BY
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
Plan Check No ..................
BUILDING
Valuation
Fee
Receipt No.
Z
1 is�-00
1,00
PROPOSED USE
PLUMBING
03
PLOT PLAN (Indicate Building setbacks, abuttlng streets)
t
N
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given in 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 Coda 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 corn-
pleted In six months.)
ATTEISMON 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 DIRE ORB SIGN T
DEPARTMENT Y
CITY OF Z.74
DATIr
EDIVIONDS
PH 0-1107
FILE
810 TURE (OWNER OR AGENTI
'R
4w.e,2
L
DATE SIGNED
0
1 7/9
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private Property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
nusrquees. ate.) will require separate pennisslon.