700478.pdfa
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BUILDING DEPARTMENT
Applicant Fill
PERMIT APPLICATION
Inside licavy Lines
NAME (AAM BUSINESS)
jr.6-
Cal 5'
K16 7 ir
t/
CITY I
TELEPHONN NUMBER
MF
I�WAf
7-
NAME
bF&
III —A DRESS
6
aCITY TELEPHONE NUMBER
10 1
Z
or Attach Four Copies)
DNEW
ADD
F] ALTER
E] REPAIR
rul
L/N, RESIDENTIAL
1 1:1 NON-RESIDENTIAL
EJDEMOLISH
EXCAVATE
El OR FILL
PRE -MOVE
1:1 INSP.
El
El
GAS
LINE
SIGN
RETAIMNG
WALL
FENCE
( .......... x .......... Ft.)
SWINI
POOL
TUMI-B—LI1 OF STORIES
NUMBER OF
DWELLING
UNITS
,�OSTED ON KROLL MAP NO.: PERMIT
krUMBER
700478
OB ADDRESS
6V
31DE YARD SET11AUK Wkls�" SETBACK
REAR YARD tjkT1:13ACI(
yh L�
LOT
USEeNE AREA
VACANT SITN Z
2
1
0
0 YES )RfN-- 0 Z
0 YES N
B LDING A-REA
ER
VARIANCE NUMBER
VARIANCE U1,IB
___UVEI
PLOT PLAN
STREET R/W
Y THIS PROPERTY
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. .
............ FT.
REMARKS
Z Z
CHECKED By
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
REMARKS
TYPE "hNNECTION
VERIFIED BY
PERC_.TEST
PERMIT NUMBER
Cd
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES NO
C] YES [] NO
PLAN CHECKED By
REMARKS
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
w
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given is correct; and that I tam the owner, or the duly author-
Ized agent of the owner._1 agree to comply with city and state laws regu-
ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employed In vlolatlon of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except I)EMOTATIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
OWNER Oft AGEN DATEMIGNED
INSPECTION
0,
nzz:;
DEPARTMENT
6 0
;
CITY OF
r51JiVLVNDS
NOTE: Applicant Subject to Plan Check Fee
IVR 0-1107
Thin Permit covers work to Ito done oat private pruperty ONLY.
Any construction an the public domain (curbs, sidewalks, drivewsLys,
marquess, etc.) will require separate permission.
Valuation I Fee
0 0
No.
1 .1. 0 Z) IfUS, If �) a
APPLICATION APPROVAL
This application is not a permit until
Signed by the Building official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
.1
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