690272.pdfI-
BUILDING DEPAKIMMI I Apilucantriiii
PERMIT APPLICA inside Heavy Lines
NAME (OR NAME OF BUSINESS)
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-MAILING ADDREB13
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0 CITY
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NAME
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of Property (Show Below or
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NEW
[;4�ADD
ALTER
REPAIR
R*RESIDENTIAL
1 11 NON-RESIDENTIAL
DDEMOLISH
EXCAVATE
F] OR FULL
PRE -MOVE
F] INSP.
El
El
GAS
LINE
SIGN
RETAINING
WALL
PENCE
( .......... x .......... Ft.)
swim
POOL
,IUMBER OF STORI U_S�'
I NUMBER 0 F
DWELLING
UNITS
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pAf��ndlcate Building setbacks, abutting streets)
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I hereby acknowledge that I havu read tWa 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-
lating construction; and In doing the work authorized thereby, no person
will be 2mployed In violation of the Luber Code of the State of Washington
relating to Workmen's Compensation Insurance.
Pe it Limit One Year (Except DEMOLITIONS which
mp
1el a2' nbon c 'd In 'n'Incty days: MOVED -IN BUILDINGS shall be com
t'
plot I In Ix �nths.) 14
MR/200 NJ
NOTE. Applicant Snbject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any constructIOR all tile public donlain (curbs, sidewalks, drIvowaYs,
marquees, etc,) will require nep"ate Perallsalon.
t
70—N KROLL MAP NO.:
PERMIT
NUMBE
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690272
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T S I, T I K
YARIj BTBACK 75REET SETBA
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L E R R
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0 YES
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NA
A En
VARIANCE NX 1 B
V I iCE
,OT PL N F VED
STREET R1W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ IT.
ZMARKS
t �CIIECKED BY
LETER SIZE I �SERVICE -SIZE- 'I CLUARANCE CHECKED BY
LEMARKS
IYPE CONNECTION VERIFIED BY
'ERC. TEST I PERMIT NUMBER
REMARKS
FIRE ZONE TYPE
777_ 1 _V1 I Ej YES a-VO
-MwECIAI, �;Rr_.0TUI1RrDI OCCUPANCY GROUP
rl YES I _r
PLAN CIIECK;VY
I'lan Check No.
BUILDING
PLUM13ING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
IILTTENTION
THIS FER311T
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EMINIONDS
I'll, 6-1107
rZ
i:
14
Valuation I Fee I Receipt No.
I/--
.x,c:> 0 j(,.0714
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-
imowledged in space provided.
FILE