700272.pdfPOSTED UN _XROLL MAP NO-: PERMIT
NUMBER -7o02�2
BUILDING DEPARTMENT Applicant FIU
PERMIT APPLICATION Inside Heavy Lines jog
ADDRESS
/ if �-/
NAME (OR NAME OF BUSINESS)
A
A-Z/ 41-l's 4S7--
SIDE YARD 8 CK STREET SETBACK REAR YARD SETBACK
a
'N
MAILING ADDRESS
M AIL
P'
USE ZONE VACANT SITE
YES AD
HEIGHT BUILDING AREA-1 VARIANCE NUMBER
C L Y
CITY
e4j C3 0 C/
rELEP.HONE NUMNLEIt
L
N NAME
PLOT PLAN APPROVED
ADDRESS
STREET R1W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT- ............
CITY
11 TELEPHONE NUMBER
NAME
C4 ADDRESS
c)
CITY
L
C] YES [] rTO
RESIDENTIAP
GAS
LINE
C] YES
E] NEW
PLAN CHI
NON-RESIDENTIAL
SIGN
E]
ElDEMOLISH
RETAINING
WALL
REMARKS
'ALTER
EXCAVATE
OR FILL
PENCE
( x Ft.)
.......... ..........
E:]PRE
REPAIR
-MOVE
INSP.
SWIM
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
I hereby neknowledga that I have read thin application; that the In-
formation given to correct; and that I am the owner. or the dully author-
lzed agent of the owner. I agree to comply with City and state lawn 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.
N E. Permit Limit One Year (Except DE51OLITIONS which
a I netll b' completed In ninety days; MOVED -IN BUILDINGS shall be core-
1,
let In six months.)
/V �Ilv �,� ap 77,k) I
i0TE: Ap�cant Suvect to Plan Check Fee
This Permit coven work to be done on private propert;7 'ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
MIMI'
CD O;D;D- Ll
q 0 0 "), q. '/
Fee I Receipt No.
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE:
TOT AMOUNT
C
14
ATMNTION
APPLICATION APPROVAL
ER
TIHS PERMIT
US 7 51
T7
This application is not a perralt until
AUTHORIZES
signed by the Building Official or Ws Dep-
rAE
ONLY TILE
WOnK NOTED
uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
INSPECTION
DIRECT R SIGNATURE /
EPARTUENT
D DEPARTUE
CITY OF
DATE
EDAIONDS
Pn 6-1107
FILE
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RECORD OF INSPECTIONS
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Date Passed
Foundation
Plumbing (Partial)
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Drainage I
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Sewer,
Parkin
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4P P1 La ndsca ping
Fire rDept r