690390.pdfCA
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BUILDIN6 DEPARTMENT Applicant Fill
Inside 11cavy Lines
PERMIT APPLICATION
NAME (OR NAME OF BUSYES�_
IX
arMAZZ
or
ElNEW
A1JJJ
ALTER
RESIDENTIAL
I
NoN-RESIDENTIAL
[:J
GAS
LINE
SIGN
RETAINING
WALL
VENCE
( ......... x .......... Ft.)
D
D DEMOLISH
EXCAVATE
0 OR FILL
REPAIR
PRE -MOVE
INSP.
0_
swim
POOL
IJUMBER OF STORIES
f
NUMBER OF
DWELLING
UNITS
......... .... .
L
ISTED ON KROLL MAP NO.: PERMIT
6(30^)Ano
.17
B ADDRESS
DE YARD2IFBAcK
t
erR EET BET13ACK
REAR YARD INTBACK
ISE ZON
LOT AREA
VACANT SITE
X�'C—
?
IL
I rml YES
/) 0
r�TTREET R/W ............ FT- DEFICIENCY THIS PROPERTY
PLAN ST. R/W ............ IrT- ............ FT.
[] YES [] NO
PLAN CHECKED BY
1,472 �2,
Plan Check No ..................
BUILDING
—ER—OPOSEID) USE
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in.
formation given Is correct; and that I am the owner, or the duty author-
ized agent of the owner. I agree to comply with city and state laws regU-
ATTENTION
latlog construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance-
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Excert DE51011TIONS which
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
AQ
(OWNER ON ENT)
INSPECTION
SIGN URE
DEPARTMENT
62 1,71 6
CITY OF
QYMNDS
NOTE: Applicant Subject to Plan Check Fee
PR 6.1101
This Permit covert work t4) be done on private PrOperly ONLY -
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require 80P&Mte PcrrrJ@610n-
[J YES [J NO
I.
Z
rA
No.
APPLICATION APPROVAL
This application is not a perntit until
Signed by the Building official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
I
G
I , . ' , L- - -1 - I - . -, I