690439.pdfPOSTED ON KROLL MAP NO.! PERMIT
690439
BUILDING
DEPARTMENT
I NUMBER
Appll
PERMIT APPLICATION
NAME (OR NAME OF BUSINE
C4 )O�e ;7
= Z
MAILING ADDRESS
�3 X1 T e-1
Inside Heavy Lines
/� AJOd WA), )yJ
ADDRESS
CITY
STATE LI
.4
or
1/ 5
RESIDENTIAL
r-1
GAS
LINE
NEW
I
LEINON-RESIDENTIAL
EJ
ADD
SIGN
RETAINING
WALL
DEMOLISH
EXCAVATE
FENCE
ALTER
OR FILL
( x Ft.)
REPAIR
PRE -MOVE
.......... ..........
SWIM
INSP.
POOL_
NUMBER OF
DWELLING
UNITS
;ATUR F WORK TO BE DONE
501
SETBACK REAR YARD SETBACK
13 YES
NUM13ER
VACANT SITE
0 NO
ILDING AREA I VARIANCE
EXISTING -STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... XIT. ............ IT.
0 YES [] NO
Plan Check No .....................
BUILDING
PLUM13ING
HEAT & GAS LINE
PENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I EXCAVATION OR FILL
I hereby acknowledge that I have read this 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 employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
ZZ
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction an the Public domain (curbs, sidewalkas driverwayst
marquees, etc.) will require sepamte perrnisslon.
Valuation
[] YES [3 NO
Fee
Z
N
No.
TOTAL AMOUNT DUE
A171% ION
APPLICATION APPROVAL
TIU14 PERMIT
This application Is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
RECTOR!
DEPARTMENT
CITY OF
PR 6-1107
I
RECORD OF INSPECTIONS
Date Passed
Drainage
Sewer
Parking
Landscaping
Fire D,-,pt.