680518.pdf17
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1: POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant M NUMBER 680518
PERMITAPPLICATION Inside"cavy Lines JOB ADDRESS
NAM (Olt NAME 01,"13USINESS) efll ;7
1, SIDE YARD I TIACK STREET SETBACK UEAR YARD ETBACK
I "v�i fL. L/ 17 -f
74AIIING ADDRESS V
r 1 .1 / I VACANT SITE
_U`1_3E_;__FZ0_iff LOT AREA
CITY TELEPHONE NUMBMK Y_ YES -�JCNO
NUMBER
HEIGHT BUILDING AREA VARIANCE
NAME! PLOT PLAN APPROVED I
ADDRESS
STREET RIW
CITY TELEPHONE NUMBER EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ........... a
REMARKS
NAME:
ADDREBB
CHECKED BY
CITY TELEPHONE NUMBER
STATE LICENSE NUMBER CITYLICENSE NUMBER METER SIZE SERVICE SIZE CLEARANCE ICHECKED BY
REMARKS
Log tion of Prrrty (Show Below or Attach Four Copies)
TYPE CONNECTION VERIFIED BY
Z
PERC. TEST PERMIT NUMBER
REMARKS
CTION
FIRE Zo TYPE YOFTRU STREET IMPROVED
[] YES [3 NO
sp AL INSPE UIRE OCCUPANCY CHO
RESIDENTIAL GAB 0 YES 0 N, I —
E] NEW LINE PLAN CHECKJfV By NJ
NON-RESIDENTIA.L SIGN
RETAINING REMARKS
DEMOLISH WALL
ALTER EXCAVATE FENCE
M OR BILL ( .......... x .......... Ft.)
REPAIR E] PRE -MOVE swim
INSP. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation Fee Receipt No.
Z
Plan Check No .....................
PROPOSED- U13E
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets) PLUMBING
CQ
HEAT & GA13 LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
77�_q
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-
tzed agent of the owner. I agree to comply with city and state laws mgu- ATTENTION APPLICATION APPROVAL
lating construction; and in doing the work authorized thereby, no persoa
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHOIUZES signed by the Building Official or his Dep-
ONLY THE
NOTE: Permit Umit one Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt Is ac-
shall be completed in ninety days; MOVE114N BUILDINGS ahall be com- Imowledged in space provided.
pleted In six months.)
SIGNATURE (OWKE—ROR AGENT) DATE SIGNED INSPECTION S'L'
TGE
DEP. ARTMENT
1ITY OF DATM
EINVIONDS
NOTE: Applicant Subject to Plan Check Fee PH 0-1107
This rerffat covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate permission.
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