750103.pdfPlam Check N. .....................
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BUILDING DEPARTMENT ApplIcant Fill
USE NUMHER 7501 iD3
PERMIT APPLICATION Inside Heavy Lines
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ADDRESS
PLOT PLAN (Indicate Building setbacks, abutting streets)
NAME (OR NAME of BUSINESS) 12
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PERMISSIBLE ^ ACTUAL
IAT COVERAGE' LOT COVESiAGE
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MAILING HOUR---
/ -1 PERMISSIBLE HEIOILT PROPOSED HEIGHT
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WALL
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TELEPHONE NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
SWIMMING POOL
DEMOLITION
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REQUIRED YARDS PROPOSED YARDS
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NAME FRONT HIDE REAR FRONT BIDE REAR
Ihereby acknowledge that I have read this application; that the In -
TOTAL AMOUNT DUE
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formation given le correct; and that I am the owner, or the duly author -
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ADDRESS
LEGAL LOT VARIANCE ON CONDITIONAL USE
C3 YES [3 NO PERMIT NUMBER
1x d agent of the owner. I agree to comply with city and state lawn r.gu.
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Iating construction; and In doing the work authorised thereby, no person
PLANNING DEFT. -APPROVAL DATE:
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will be employed in violation of the Labor Code of the State of Washington
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This application is not a permit until
CITY TELEPHONE NUMBER
relating to Workmen'. Compensation Ia.urance.
AUTHORIZES
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STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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ONLY THE
µ•ORR NOTED
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COMP. PLAN 0T. R/W ............FT. ............FT.
shelf bo completed In ninety days; b10VED-IN BUILDINGS shall be cam-
DINGS hall
knowledged in space provided,
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RESREMARKS
ADDRESS
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CHECKED BY
SIGNATURE (OWNER AGE T) DATE SIGNED
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DEPARTMENT
CITY
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TELE�PHONE NUMBER
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METER 131ZE SERVICE SIZE CLEARANCE
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NOTE: Applicant Subject to Plan Check Fre
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
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This PermitPermitarra work to be acne on priests property UNLY.
Any construction on the public domain (curbs, sidewalks, drl—Y.,
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REMARHH
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Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION VERIFIED BY
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PE11C. TEST
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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13 YES []NO
SPECIAL INSPECTOR REQUIRED G
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® RESIDENTIAL 6 NE
(OCCUPANCY
YES ❑ NO
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PLAN CHECKED IIP THIS SITE IS LOCATED IN THE CITY
LoNON-RESIDENTIAL SIGN
TAX
OHOUID
- ADD RETAINING
BE CODEDOCAL 31045ALE5
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DEMOLISH WALL
ALTER EXCAVATE FENCE
OR FILL* ..... ........... Ft.)
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REPAIR E]IN MOVE EJ BOOL
NUMBER OF BTORLES NUM
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UNITS
Plam Check N. .....................
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BUILDING
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C, PROPOSED USE
PLUMHIN6 �
PLOT PLAN (Indicate Building setbacks, abutting streets)
BEAT & GAS LINE
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FENCE
SIGN
tRETAINING
WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Ihereby acknowledge that I have read this application; that the In -
TOTAL AMOUNT DUE
Y0
formation given le correct; and that I am the owner, or the duly author -
1x d agent of the owner. I agree to comply with city and state lawn r.gu.
ATTENTION
APPLICATION
Iating construction; and In doing the work authorised thereby, no person
APPROVAL
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'. Compensation Ia.urance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except which
ONLY THE
µ•ORR NOTED
Uty; and fees are paid, and receipt is ac -
shelf bo completed In ninety days; b10VED-IN BUILDINGS shall be cam-
DINGS hall
knowledged in space provided,
plete
pletetl In sixmonths.)
SIGNATURE (OWNER AGE T) DATE SIGNED
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INSPECTION -
DEPARTMENT
D1Rf OR'0 iHONATU}lE - ^
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CITY OF
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NOTE: Applicant Subject to Plan Check Fre
EDbWND$
DAT �
775-2525
This PermitPermitarra work to be acne on priests property UNLY.
Any construction on the public domain (curbs, sidewalks, drl—Y.,
marquees, Ole.) will regmre separate permission.
FILE