710111.pdfi
POSTED ON KROLL MAP NO.: I PERMIT
7l O l I I
BUILDING DEPARTMENT ApplIcantFill
PERMIT APPLICATIOW Insido Heavy Linos JOH�jADDRESS -
I NAME (O h I %% ..-i. — Y / U-c-•-C�c.c.- e• w
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or
EJNEW
RESIDENTIAL
❑
GAS
LINE
NON-RESIDENTIAL I
❑
❑ ADD
SIGN
RETAEl INING
❑
DEMOLISH
O
EXAVATE
ALTER
El
ORCFILL
❑
(ENC x
Ft.)
REPAIR
IN PRE-P.
..........
POOSWIL
(UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
SIDE YARD SETBACKI
STRE T SETBACK I
REAR YARD SETBACK
USE ZONE
I LOT AREA
VACANT SITE
❑ YES ❑ NO
HEIGHT
I BUILDING AREA
I VARIANCE NUMBER
PLOT PLAN APPROVED
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
FIRE ZONE I TYPE OF
❑ YES ❑ NO
REMARKS
_
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING
,VALL
N
`
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
DEFICIENCY THIS PROPERTY
STREET IMPROVED
❑ YES ❑ NO
Valuation I Fee
No
No.
jha
_--- TOTAL AMOUNT DUE ``Q
I hereby ecknowledgo that I hove readthis appllcntlon;a in- J�LlUformation given Is correct; and that I am the owner, or thethor-
ized agent of the owner. 1 agree to comply with city and starogu- AT`i'ENTION APPLICATION! APPROVAL
Iating construction; and in doing the work authorized thereersonwill be employed In Violation of the Labor Code of the State ongton THIS PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
i� E:Perm' Limit One Year (Except DEMOLIwhich WORK NOTEDUty; and fees are paid, and receipt is ac-
ehall o comp1 ed 1 ninety days; MOVED -IN BUILDINGS com- knowledged in space provided.
plet In six oath1G ATUR (OW R Oft AGENT) DAT'D INSPECTION DI OR'SDEPARTMENTCITY OFEDhIONJ DATNOTE: Applicant Subject to Plan Check �a
PR 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate permission.
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i Drainage 1 ,
_ Sewer
1 Parking.
Landscaping
c Fire Dept.