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BUILDING DEPARTMENT
Applicant Fill
PERMIT APPLICATION
Inside Heavy Lines 7GS
NAME (OR NAME 01F BUSINESS)
Jay-Bor Inc*
7MENG
ADDPX8S
us,
105,10 Oak Road
CITY
waujaPSONE NUMBER
413115
1 334-2022
NAME
�J- P, n-
ADDRESS
1 0 _�� 0 C) PITH
EX3
CITY 1111ONE NUMBER
(j
LA �J- :� Ij
NAME Di
ADDRESS
16 �D A
CITY TELEPHONE NUMBER
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1W,_1F_ �Y 54 - 24CD 2, 70
13TATE LICENSE R—UMBER CrA7x JAUNN
RE
Legal Descriptlon-of Property (Show Below or Attach Four Copies)
A,/ /-C 7- 4- 0 C -4
PE
L n- L r,-,)- LA up
SE
GAS 13
NEW RESIDENTIAL El LINE P3
DNON-RESIDENTLILL El SIGN
El�w RETAINING
ElDEMOLISH 0 WALL
El ALTER EXCAVATE PENCE
n OR FILL ( ........ . x . ........ irt.)
REPAIR PRE -MOVE SMM
0 INSP. POOL
NUMBER OF STOIU
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO 13E DONE
r
PROPOSED USE
Building streetz)
PLOT PLAN (Indicate setbacks, abutting
I hereby acknowledge that I have read this application; that the in-
formation given to correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city end state laws regu.
latlng 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 Workman's Compensation Insurance.
NOT : Permit Limit One Your (Except ]DEMOLITIONS which
shai compl d In ninety days; MOVED -IN BUILDINGS shall be conn-
pl six Ulm.) .94
NA W74E GEN
DATE SIGNED
NOTE: APPlicant Subject to Plan Checle Fee
This permit oovers work to be done an private Property Ordlux-
Any OonstrOcUon an the public domain (curbs, sidewalks, driveways,
marquess, e".) will require separate pennisslon.
W 4
DN KROLL MAP NO.: PERMIT -7
1 NUMBER 100043
IESS rA
.,3 / co �aA LIE,
RD SETBACK STREET BEWBACK REAR YARD SETE
LOT AREA W=rrm
appleff- [3 NO
FE2Z'W
STING STREET /w.44.0irr. DEFICIENCY THIS PROPERTY
DUP. PLAN ST. �1wr-6Z.rr.
7iveway sioOes not to
,5 ff tv eK
YES
,AN
.1�
ton Check No....
UILDING
LUMBING
MAT & GAS LM
'ENCE
1IGN
IETAINING WALL
IWIMKING POOL
3EMOLITION
?RE -MOVE INSPE CTIOZ
MCCAVATION OR FILL
TOTAL AMOUNT
e
I
[3 YES 9-ST
Fee
I
No.
1,TTENT[ N APPLICATION APPROVAL
r, ,
THIS PERB T This application is not a permit until
uty; and fees are paid, and receipt is ac-
.41 knowledged in space providecL
AUTKOWZ signed by the Building official or his Dep-
ONLY
WORK N D
CITY
PE
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WAFE
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