710404.pdf•
POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT
APPllcant Fill
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PERMIT APPLICATION
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JOB ADDRESS
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NAME (OR NAME OF BUSINESS)
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SIDE YARD SETBACK
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STREET SETBACK, REAR YARD ShT➢ACI<
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Legal Description of Property (Show
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.CANT BITE�/ Ii
YES yv0 �
YTIIEET R/W EXISTING STREET R/W ��,,6�..rv4T. DEFICIENCY THIS PROPERTY
1.te: COMP. PLAN ST. R/W 5FT. •. ••FT•
„EMnxxB Driveway slopes not to exceed those
Lndicated on Standard Drawing #103.
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SPECIAL•INSPECTOR REQUIRED OCCUPA CY I ❑B TUP
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rviRESIDENTIAL ❑ LINE PLAN CHECKED BY
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NEW
NON-RESIDENTIAL ❑ SIGN THIS SITE IS LOCATED IN T E
❑ ADD RETAINING REMARKS U . LOCAL SA E
❑ DEMOLISH ❑ WALL TAX SHOULD BE CODED 31.
M.
❑ ALTER ❑ ORCAVATFILL E ❑ (ENC.x.......... Ft.)
STRJG`CU - �
REPAIR E]PRE-MOVE ❑ SWIM p C/y UlE "r FeuC�SE
INSP. POOL VL'oLY . ��1I S P SEC- ►2 . �3 r o+.}
IMBER OF STORIES NUMBER OF �'n011(DT✓ �]O �..�Q' Rr1S
DWELLING UNITS �hrcAed FA. GU I IES
JATURE OF WORK TO BE DONE
_ I Valuation I Fee Receipt No.
/ r '� Vv / • �. w Plan Check No .....................
BUILDING
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PROPOSED USE
_LSD
PLUMBING
a PLOT PLAN (Indicate Building setbacks, shutting streets) HEAT A GAS LINE
+�'1
5
n FENCE
SIGN
RETAINING WALL
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I SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
hereby acknowledge that I have rend this application; that the In -
on given is correct; and that I am the owner, or the duly author-
ent of the owner. I agree to comply with city and elate laws regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and 1n doing the work authorized thereby, no Deteon
employed In violation of the Labor Code of the State of Washington
TINS PERMIT
This application is not a permit until
to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
: Permit Limit One Year (Except DEMOLITIONS which
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ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ae-
e completed In ninety days; MOVED -IN BUILDINGS shall be com-
Imowledged in space provided.
fn six months.)
URli (OWNER OR AGENT) DATE 816NED
INSPECTION
DIDEPARTMENT
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CITY OF
NOTE: Applicant Subject to Plan Check Fee
EOMONI
DATE
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This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
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marquees, etc.) will require separate permission.
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