680525.pdfKROLL MAP NO.: PERMIT
NUMBER
BUILDING DEPARTMENT Applicant 11111 POSTED ON I
PERMIT APPLICATION Inside Heavy Lines joB ADDRESS
NAUR (OR NAME Oy Z7
SIDE YARD SETBA K STREET SETBACK REAn
S
UNG ADDRESS m:n
16%7.22- &8 a) USE -itol. LOT A.RE
i F�T� i TELEPHONE NUMBER I tkl ME C3 YES
14 AIJDRESS
0 1-5-?z 2 - & r Owe.
9 _CIT
STATE LICENSE NUMBER
17,�'l - 6:f 0 f
or Attach Four Copies)
;;;Zis-1�17NO'S'TREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ........... PT. I
REMARKS
Driveway slopes not to exceed those
indicated on Standard Dmuring #103.
13 YES 13 NO
g- I _J�
NEW K—RESIDENTIA PONSCHECKEAVY'lo
.j
NON -RESIDE TIAL SIGN
q,
RT LINING REMARKS
WALL
4. DEMOLISH PENCE
ALTER EXCAVATE
ORFIIJ .......... x .......... Ft.
REPAIR PRE -MOVE SWIM
El INSP. POOL
-NUMBER OF STORIES- NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
le Valuation Fee Receipt
Z
Plan Check No ............ . .......
101*11 USE
BUILDING
PLOT PLAN (Indicate Building metbacRY —abutting streets) PLUMBING
HEAT & GAS LINE
PENCE
t SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge Mat I have read thin application; Mat the in' TOTAL AMOUNT DUE
formation gIvan is correct; and that I am the Owner, or the duly author-
ized &Sent of tile owner. I agree to comply with city and state laws regu- ATTENTION APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor "a of the Slats Of Washington THIS PERMIT This application Is not a permit until
relating to Workman's COMPeWlAtIOM Insurance- AUTHORIZES
ONLY THE signed by the Building Official or his Dep-
NOTE: Permit Limit One Your (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
shall be completed in ninety days; MOVED -IN BUILDINGS shall be oom- Imowledged In space provided.
plated In six months.)
SIGNATURE (OWNER OR AGENT) )ATE SIGNED INSPECTION _DIRECTOWS SIGNATURE
DEPARTMENT
CITY OF DATE
NOTE: Applieant Subject to Plan Cbeck Fee PH 6-1107
This Permit coven work to be done on priv"e Property ONLY -
Any construction on the public domain (curbs, sidewalks, driveway#, Tax
marquees, c4c.) will MQulm separate permission-