690279.pdfn
TED UN KROLL MAP NO.: PERMIT
NUMBER 1� 0279
BUILDING DEPARTMENT Applicant FI
ADDRESS �?V.2
((;Ljp!�MN ?.F W!N
PERMIT APPLICATION Inside Ileavy Lines j ug
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AV 81- 77 1/ 11�
I CITY LICENSE NUMBER
3ow Below or Attach Four Copies)
DNEW
RESIDENTIAL
-1
F
GAS
LINE
NON-RESIDENTIAL
El
SIGN
AVV
RETAINING
ElDEMOLISH
WALL
DALTER
El
EXCAVATE
OR FILL
0
FENCE
( x Ft.)
........ . ..........
REPAIR
F-1
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF
DWELLING
UNITS
4ATURE OF WORK TO BE DONE
SIDE YARL) ULTBAUM til:ltaa�
USE ZONE LOT AREA VACANT SITE
rl YES
_71Q, MMING AnEA
V
MITREET R/W ............ FT. DEFICIENCY THIS PROPERTY
PLAN ST. R/W ............ FT. ............ IV-
BY
OF CONSTRUCTION STALL
77 [3 YES
,P,EQUIRED OCCUPANCY GROUP
13 YES
Plan Check No .....................
BUILDING
PLUMBING
A
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION On FILL
I
N',
TOTAL AMOUNT DUE
TOTA L "'OU
I hereby acknowledge that I have read this application; that the In-
A
formution 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 stRto laws regu�
ATTENTION
ATTEN ,
T
toting construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
1119
THIS PEBMIT
T PL
'It,
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE31011TIONS which
ONLY THE
% I" I
WORK NOTED
I
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six menths.)
IIGNATURE (OWNER Olt A.GLN'I*)/ DATE SIGNED
V
-I
INSPECTION
DEPARTM , ENT
a
7-c�J-4?
CI
CITY OF
C
NOTE: Applicant Subject to Van Check Fee
PH 6.1107
This Te-mlitelvIrs work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
Clow
Fee
0
Z
W
W
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.
M
FILE
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