710529.pdfr
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BUILDING DEPARTMENT
PERMIT APPLICATION
1 NAME (OR 7XME OF BUSINESS)
Applicant Fill
Insole Heavy Lines
CITY -
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ADDRESS -
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NAME _
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ADDRESS
CITY ITELEPHO
STATE LICENSE NUMBER I CITY LIC.
-171
RESIDENTIAL
�.
GAS
LINE
NEW
-
NON-RESIDENTIAL
❑
SIGN
ADD
WALL
❑RETAINING
El ALTER
❑
DEMOLISH
EXCAVATE
ORFILL
(FENCE
..........Ft.)
REPAIR
❑
Pwim
RE -MOVE
POOL
OOL
DWELLING
UNITS
& 4"00
4LL
POSTED ON KROLL MAP NO.: PERMIT
I NUMBER
710'Jr_
/�O
JOB ADDRESS
SIDE YA D/BETBACKI STREET SETBACK (REAR
11 � ate'
YARD SETBACK
USE N LOT AREA
VACANT SITE
I
YES NO
ItEIOHT I BUILDING AREA
I VARIANCE NUMBER
t
N
I
PLOT PLAN APPROVED
Z
W
STREET R/W
EXISTING STREET R/W ............FT-
DEFICIENCY THIS PROPERTY _.
COMP. PLAN ST. R/W ............FT.
.........FT.
REMARKS -
0
-
-
Z
W
-
---
CHECKED BY
METER SIZE
-.SERVICE SIZE
CLEARANCE.
CHECKED BY -
I
I
Cd
pyd�
F
REMARKS
r
TYPE CONNECTION
(VERIFIED BY
PERC. TEST
-
PERMIT NUMBER
p;
I
REMARKS
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 person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmea's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit corers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) win require separate permission.
FIRE ZONE I TYPE Or. CVNtlTitUV'11VC1 - I ❑ +" S NO
SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP
YES NO
PLAN CHECKED BY THIS SITE IS LOCATED IN THE
TAX SHOULD BE CODED 31.04.
i9« Z42101ePs-g (ode-1970
Valuation
Plan Check No ....................
BUILDING
PLUMBING VV ( l
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE I
Fee
RO
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
uty; and fees are paid, and receipt is ac-
WORK NOTED
knowledged in space provided.
INSPECTION
—DIRECTlzm�;
DEPARTMENT
CITY
DATE
ED D
& _ 3 _ 7/
rR -lloT
6-1107
FILE
10