700555.pdfL
POSTED ON PERMIT
KROLL MAP NO.:
rMUBER
BUILDING DEPARTMENT 700555
Appileant Fill
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
-UM� — — 9 1�� -
NAME (On NWRIE /5' 0 0 �(
SIDE: YARD BET13ACK STREET BETBACK REAR YARD SETBACK
L-7Aa--7vft
Mfu ADDRESS 1 0
VA 7—
EN BE [3 NO
YES
USE ZONE LOW AREA CAN SITE
CITY 1
BUILDING AREA VARIANCE NUMBER
7
P/7 TINEI—GHT
j, NAME
PLOT PLAN APPROVED
ADDRESS
STREET R/W
UMBER EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
CITY TELEPHONE N
COMP. PLAN ST. R/W ............ FT. ............ IT.
REMARKS
01 ADDRESS
CHECK
T207 7 z4 44 1/ ED BY
CITY TELEPHONE NUMBER
METFjt SIZE I SERVjCE SIZE CLEARANCE CHECKED BY
_2EI
LICENSE NUMBER CITY LICENSEfNUMIMR ti I.,
SI-411 jo I I
REMARKS__.,0
Legal Description of Property (Show Below or Attach Four Copies) le V
44 4
4 1, VERIFIED BY
— TIYE, CONN
— PEI PERMIT NUMBER
REMARKS V A
tip& 14 1. 7 1
FIRE ZONE TYPE OF CONSTRUCTION STREEFP IMPROVED
0 YES NO
SPECIAL INSPECTOR REQUIRED JOCCUPANCY GROUP
RESIDENTIAL
GAS
LINE
NEW
NON-RESIDENTIAL
SIGN
ADD
RETAINING
F]
DEMOLISH
WALL
EXCAVATE
FENCE
ALTER
n
OR FILL
( x Ft.)
REPAIR
E]
PRE -MOVE
......... ..........
swim
INSP.
POOL
;UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
0 YES [] NO
REMARKS
IV A-1
Plan Check No .....................
BUILDING
PROPOSED USE
PLUMBING
0
A
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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-
ATTENTION
kiting construction; and In doing the work authorized thereby, no person
will be employed in Violation Of the Labor Code of the State of Washington
TIUR PERMIT
relating to Workmen's Compensation insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except I)MMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; BIOVED-IN BUILDINGS shall be com-
�J'Acd In six months.)
G AT - URE(OWNE -
R
DATE SIGNED
INSPECTION
DEPARTMENT
0,
;4TE4:Applicant
LQL
i
CITY OF
EIMILONDS
Saject to Plan Ched, Fee
PH 8-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
No.
0 n R59 o
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-
Imowledged in space provided.
, �;7 !�
Lamm—
'40"
0