680346.pdfI
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POSTED ON KROLL MAX, NO.:
PERMIT
NUMBER
BUILDING
DEPARTMENT
Applicant Fill
PERMIT
APPLICATION
Inside Heavy Lutes
JOB ADDRELAS
NAME (OR NAME OF BUSINESS).
SIDE RD. SETBACK
Y�
STREET SETBACK
REAR YARD SETBACK
MAILING ADDRESS
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USE ZONE
ARE
LO' 'A
VAUJUN T SITE
YL 0 NO
IR, ps
I
CITY
TELEPHONE NUMBER
r-)
-1-101GHT
BUILDING
AREA
VARIX
NAUE
V— 4- tog
—
0 t,
PLOT PLAN APPROVED
STREET n/w
:,PITY
TELEPHONE NUMBER
EXISTING STREET n/w D.FT.
DEFICIENCY
THIS PROPERTY
COMP. PLAN ST. R/W
....FT.
rz
REMARKS
ZA1,
�ADDRESS
CITY TELEPHONE NUMBER
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'Legal Description of rroperty (Snow Below or Attacit. Four Copies)
NEW
ADD
ALTER
REPAIR
RESIDENTIAL
NON-RESIDENTIAL
FI DEMOLISH
EXCAVATE
E] OR FILL'
PRE -MOVE
INSP.
F-1
GAS
LINE
SIGN
RETAINING'
WALL
PENCE
( .......... x .......... Ft.)
swnt
POOL
NUL113ER OF STORIES
NUMBER OF
DWELLING
UNITS
I
I"ut. tc) --mccood tllone
oll
CHECKED BY
110
IETER 81ZE
SERVICE SIZE
CLU�ARANCE
I CHEC!KED BY
LEUARM
PLRC. TEST PERBUT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREE
4 M.3
SPECIAL INSPECTOR REQUIRED OCCUPANCY -GROUP
0 YES 0 NO
PLA ECKED BY
REMARKS
NATURE OF WORK TO BE DONE
rims. Check No .....................
PROPOSED USE
-
BUILD ING
4
PLOT PLAN (Indicate Building setbacks, abutting streets)
f
PLUMBING
HEAT & GAS LINE
PENCE
If
SIGN
N
RETAINING WALL
SWIMMING POOL
I
DMIOLITION
PRE-AIOVE INSPECTIO1,
EXCAVATION OR FILL
TOTAL AIVIOUNT 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-
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 111,1151IT
relating to Workmen'n Compensation Insurance.
AUTHORIZFS
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed it, ninety clays: 310VEID-IN ]BUILDINGS shall be com-
pleted In six months.)
9IGNATLIRE (OWNER Oft AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
E DINIONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
This Pernut etners work to he clone ,it prl%ate property ONLY.
Any construction on the public domain (curbs, midetvallim, drhoways,
inarclures, Pic.) will require separate pertulstilon.
Fee
UPROVED
[j NO
No.
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DIRECTMI-A RIGNATURE
INSPECTOR
�� I
-1 1 J
RECORD OF INSPECTION 9
Date Passed
& -
Foundation
Plumbing (Partial)
I (Rough)
Frame
------- >-Furnace & Fuel Lines-�,
Final