690351.pdfW7
POSTED ON KROLL MAP NO.:
PERMIT
NUMBER 69035 1
BUILDING DEPARTMENT Applicant Fill
Inside Heavy Lines JOB ADDREUS
PERMIT APPLICATION.
(OR NAME OF
I NAME USINESS)
6. Ald 'e-4 A
2-7 C7 -
. ..� . I
.
SIDE Y ARD BET13ACK STREET SETBACK REAn YARD SETBACK
1:
_ZU�G
ADDRESS
USE ZONE LOT AREA
box 3
CITY TEWUPAIV14M
C]YES (3 NO
HEIGHT `RUILDING AREA NOE NUMBER
NAME
_9LOT -PLAN
APPROVED
ADDRESS
STREET R/W
EXISTING STREET R/W ............
FT- DEFICIENCY THIS PROPERTY
CITY TE NUMBER
COMP. PLAN ST. R/W ............ FT. ............ FT.
REMARKS
NAME
7-Y
ADDRESS
Z
Ifzo
&NE
CHEORED BY
CITY NUMBER
TER SIZE 11FRVICE1 SIZE CLEAR ANCE CHECKED BY
STATE LICENSE RU ABER CITY LICENSE Numishat
-3 4o q-7
REMARKS
Legal Description of Property (bnow Below or At inch Four Copies)
TYPE CONNECTION
VERIFIED By
PERO. TEST
PERMIT MBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES Im
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
G1kS
RESIDENTIAL L NE
[J YES 13 NO
By
Nr NEW 1� I
PLAN CHECKED
NON-RESIDENTIAL El SIGN
DADD RETAINING
ElDEMOLISH D WALL
REMARKS
A7rhf,,?ieQ4�
D ALTER EXCAVATE PENCE
El OR FILL ........ . x ......... Ft.)
REPAIR PRE -MOVE SWIM
INSP. El POOL
NUMBER OF
DWELLING
�q d, I
UNITS
NATURE OF WOR TOBB DONE
Valuation Fee Receipt No.
aas
Plan Check No ............ ..
Z
BUILDING
PROPOSED U515
PLUMBING
& LIN ED
A PLOT PLAN (Indicate Building setbacks, abutting streets)
AT GAS
PENCE
SIGN
t
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I I L71
I hereby acknowledge that I have read this application; that the in.
formation given In correct; and that I arn the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
APPLICATION APPROVAL
letting Construction; and In doing the work authorized thereby, no person
In of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
will be employed violation
relating to Workineri'm Compensation Insurance.
AUTIIOIUZES
signed by the Building official or Ms Dep-
NOTE: Permit Limit one Year (Except DE510LJTIONS which
ONLY TIUS
WORK NOTED
uty; and fees are paid, and receipt to ac-
be completed In ulnety days; MOVED -IN BUILDINGS shall be com.
knowledged in space provided.
shall
pleted In six months.)
3
_815WATURE (OWNER NT) E SIGNED
INSPECTION
D!
DEPARTMENT
CITY OF
4e2! , �O
,
ElaMONDS
DATE
APPlicant Subject to Plan Check Fee
NOTE:
PE 6-1107
his Permit covi ers worlt to pe Go= � private property ONLY.
the pubtle domain (curbs. sidewalks, drlv*W&7S,
ruja
Any 60111stfuctiOu'un
marquees, eic.) wili require separate permission.
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RECORD UrINSPECTIONS:
!�ftf,, "wt
)ate� Passed ;r
Foundation
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ial)
...... r plumbing (Part
(Rough) I
J. Frame
"I N 0 1,
Ap
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4 4 1 Furn 'r,I
j" Final
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'IiRECORD1LOF!1NSPECTlONV
if
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Drainage
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I.Parking,
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If 44 A I
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Fire. Dept:,
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