690095.pdfWrED ON KROLL MAP NO.:
NUMBE
BUILDING DEPARTMENT Applicant Fill 690095
Inside Heavy Lines ADIMESS
PERMIT APPLICATION ----
AM OFRYSINE1�8) REAR YARD BE
41=
ST EET S TBAC TBkACK
SIDE FARD surimcim I
G RES
a- Z AREA VACANT bl'X"
LOT
VELEPHONE NUMBER YES
HEIGH AREA SE F4
BUILDING
-_�.iAME
PLOT PLAN APPROVED
DRESS
ST EET R/W
TELEPHONE NUMBER EXISTING STREET R/W ............ FT- DEFICIENCY TH113 PROPERTY
CITY COMP. PLAN ST. R/W ........
REMARKS
Z
REUS W
CHECKED BY
CITY WNL"�EVIniurim L, MBER
CITY -LICENSE NUMBER METER SIZE SERVICE CHECKED 33Y
STATE LICENSE NUMBER
REMARK13
Copies)
Legal Description of Property (show Below or Atta h Four
VERIFIED BY
TYPE CONNECT10N
............
PERMIT NUMBER
PERC. IE13T
14
/f REMARKS
0 FIRE ZONE_ YPE OF CONSTRUCTION STREET IMPROVED
[3 YES E] NO
-UPECIAL INSPECTOR RNWUIRED OCCUPANCY GROUP
__J GAS 0 YES E] NO
RESIDENTIAL LIWS' PLAN CHECKED JAY
NEW
NON.RESIDENTIAL SIGN
F� ADD RETAIITING REMARKS
DEMOLISH WALL
F� ALTER EXCAVATE PENCE
OR FILL ( .......... x .......... Ft.)
REPAIR PRE -MOVE swim
El INSP. POOL
NUMBER OF STORIES NUMBE OF
DWELLING
-9-A—TURE OF y"MRK UNITS
�Q_ I3J_DQNE
Fee Receipt No.
Valuation
Z
0 Plan Check No ................ ....
PROPOSED USE BUILDING 3
PLOT PLAN (Indicate Builling setbacks, abutting OtrCCLS) PLUMBING
0 HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIM30NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In-
formation given In correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws rcgu- ATTENTION APPLICATION APP
lating construction; and In doing the work authorized thereby, no person t until
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT This application is not a perml
relating to Workmens Compensation Insurance. AUTHORIZES signed by the Building official or his Dep-
ONLY THE
NOTE: Permit Limit one Year (Except 3)EDIOLITIONti which %VORK NOTED uty; and fees are paid, and receipt is ac-
shoal be completed In ninety days; MOVED -IN BUILDINGS shall be mm- knowledged in space provided.
pleted In six months.) ION
SIGNATURE (OWNERjOR AGENT) A T DIRE70 a
DEPARTUM
CITY OF
DATE
NOTE: Applicant Subject to Plan Check Fee PR 0-1107 .3 -
This Permit covm work to be done on private property ONLY -
Any construction on the prbllo domain (curbs, sidewalks, driveways, FILE
marquees. ate.) will require separate permission.
1 1 A - - ---I--- __ � J i
z I