690449.pdft4
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BUILDING DEPARTMENT I Applicant F111
PERMIT APPLICATION Inside 11cavy Lines
a
- 40 1 ez-
or
NEW
DRETAINING
ALTER
REPAIR
RESIDENTIAL
NON-RESIDENTIAL
Ej
GAS
LINE
SIGN
WALL
FENCE
( .......... x .......... Ft.)
SWIM
POOL
El
DEM012SH
EXCAVATE
OR FILL
PRE -MOVE
INSP.
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
0
t
N
I
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly author-
lzed 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.)
11 NATURE (OWNLIt CA AUh;14T) ��L�
tl
NOTE: Applicant Subiccl to Plan Check Fce
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways.
jj�quceg, etc.) will require separate permission.
ON KROLL MAP NO.: PERMIT
NUMBER
690449
RD SETBACK STREET SETBACK REAR YARD SETBACK
P
LOT AREA VACANT Orr %
Z
13 YES
BUILDING AREA VARIANUN NUMBER ow
Ale
4TREET R/W
EXISTING STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ............ FT.
OW41*01
7000
-</ T i 5' Z
Z
W
I
Plan Check No .....................
Valuation
Fee
Receipt No.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS 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-
Imowledged in space provided.
INSPECTION
DIRECTOR'S S71GNA0AUJ E
DEPARTMENT
CITY OF
5,
EDBIONIDS
DA!OV
PR 6-1107
FILE