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POSTED ON KROLL MAP NO.: PERMIT
710140
4 BUILDING DEPARTMENT Applicant Fill /020 Gj,
PERMIT APPLICATION Inside Heavy Lines IOB ADDRRE8801
NAME ( 8) 0 I ^ / !/ CJ /� " r X -
��1 SIDE YARD SETBACK BTFtEET SETBy�ACK REAR YARD SETBACK
pppp��77 MAI G RESS �! ' 1 i N✓ .I �t /,' ) .[/V'�.. I Ot d t
eZ /O s — /GO 1/ S. /w 1 - UB 1 I LOT AREA VACANT 8ITE
EG CITY ` { Q /Yi v r •••A IiiLE IFONE NUMBER ES NO Z
HEI`GHT I BUILDINO AREA I ARIANCE NUMBER •Wi
NAME f/ GI
`d'00e PLOT PLAN APPROVED
WADDRESS
STREET R/W �1�.�
Op� EXISTING STREET R/W 111�-�..FT. DEFIOIENCY THIS PROPERTY
C CITY I TELEPHONE NUMBER n
c COMP. PLAN 8T. R/Wl4.S,�,ems
....FT. ... �..FT. O
REMARKSNAME
/JI/O UJ Driveway slopes not to exceed those indicated'
C ADDRESS
1d2 3 —180 �� 1 on Standard Drawing #} G
CITY BY '— w
!N TELEPHONE NUMBER
x 743 `GGSS METER 81ZE SERVICE SIZE CLEARANCE HE ) Y
STLICENSE NUA113EJ'R�[ �% CITY LICENSE J
SE NUMBER y� I 2� I I //J 1
/' 9 � J `o / `- / CJ /L g I REMARKSS
Legal Description of Property (Show Below or Attach FourCopies)
// ) (2 /970
00
TYPE(;CONNECTION aVERIFM
Cly PERC. TEST I PERMIULTMEER 1..,
(xq REMARKS In
G N!
a FIRE ZONE I TYPE OF TNSrRUCT ION I � STREET IMPROVED
YES
GAS ❑ YES SPEMAL INSPECTOR O REQUIRED I OCCUPANCY III?
NEW ®RESIDENTIAL e[;)CN
LINE PLAN CHECKED 7Jy
NON-RESIDENTIAL ❑ SIGN /
ADU ❑ DEMOLISH RETAINING IQING REMARKS D
ALTER ❑ OR AVATE FULL ❑ PENCE
s.......... IY.)
REPAIR PRE-MOVEO Pwim
OOL _
NUMBER OF STORIES NUMBER OF
DWELLING /
UNITS
NATURE WORK;? DONE ONNE// Valuation Fee Receipt No.
Z4 Cie— Plan Check No .....................
t0Fr BUILDING /
i PROPOSED USE (
yea jig
PLUMBING
U
aPLOT PLAN (Indicate Building setbacks, abutting streets) HEAT & GAS LINE
n
FENCE
SIGN
RETAINING WALL
N
ISWIMMING 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-
lating construction; and In doing the work authorized thereby, no persol:
will be employed In violation of the Labor Code of the State of Washington 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
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com- knowledged in space provided.
pleted In six months.)
SIGNATURE NER OR AGEN I VP
E 8I0NED INSPECTION DIRECTOR'S fONATUI
DEPARTMENT
1-3 / CITY OF DATE /
ED51ONDS
NOTE: .Applicant Subject to Pla)I Check Fee
PR s-Iloi /
This Permit coven work to be done on private properly ONLY.
Any cunstructloa on the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate permisslon.
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