750168.pdfr
7"
Plan Check No—- ................
BUILDING
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PROPOSED USE
BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
InBldo Heavy Lines
ZONE - (, NUMBER
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ADDRESS
PLUMBING
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NAMFF�� (OA NAME OF 8 8 EBB)
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ry(, ST w,O A7J LOT COVERAO7.-i< LOT COVERAGE^�'
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MAILING ADDRESS 'pE1N1]8B16LE HEIOI` D . PROPOSED HEIGHT
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8 1>�. AREA
CITY //
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TELEPQH�ONE NUMBER
7� •5/ L. /
ACTUAL`/ f ARE Tj)TAIy
REQUIRED YARDS Qrj�/f . PROPOSED YARDS
PLOT PLAN (Indicate Building setbacks, abutting streets)
NAME / F�tR�O1NT 81DE REAR FRONT�1 BIDE
!XVr S� tY S�
LEGAL LOT VAIiIANCEX (HICA/
ADDI(EBB
Ej YES [] NO PERMIT NUMBER
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PLANNING DEPT A Y O D
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CITY TELEPHONE NUMBER )
I STREET R/W •
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
NAME
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ADDRESS
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CHECKED BY
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CITY
TELEPHONE NUMBER
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METER SIZE SERVICE 872E CLEARANCE
CHOCKED 8Y
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O STATE LICENSE NUMBER
CITY LICENSE NUMBER I
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PRE -MOVE INSPECTION
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Legal Description of Property (Sho • Bel— o/z�Altneh Four Cople-e1)
EXCAVATION OR FILL
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KP LS O QQ PLA L 0 1� A N (LS
TYPE CONNECTION VERIFIED BY
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PER`. TEST PEREfIT NUMBER
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REMARKS
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TOTAL AMOUNT DUE
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FIRE �pWS I TYPE OF CON81`RUC TION I STREET IMPROVED
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farmatlon given In correct; and that I am the owner, or the duly author-
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❑ YES 0 NO
ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUPGAS
it
toting conetructlon; and in doing the work authorized thereby, no Person
RESIDENTIAL ❑ LINE
NEW
NON-RESIDENTIAL SIGN
❑pLANBCHECKED BYO—'
THIS SITE IS LOCATED IN THE CITY
OF 'DMO N DS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
will be employed Ia vkdallon of Na Labor Code of the Stale of Washington
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❑ DEMOLISH
ALTER EXCAVATE
OR FILL
RETAINING
WALL
FENCE
(......__x .......... Ft.)
REMARKS
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AUTHORIZES
❑ REPAIR [:]INEPMOVE
❑ POOL
NOTE: Permit limit One Year (Except DEMOLITIONS which
1
uty; and fees are paid, and receipt is ac-
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s
NUMBER OF STORIES I NUMBER OF
DWELLING
t UNITS
plelcd In sixmonthe.)
No.
NATURREE� OF (WORK TOO BE 'D NE
0 1Q] `
c sem
yethation
Fee
Receipt
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DEPARTMENT
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Plan Check No—- ................
BUILDING
TT
PROPOSED USE
1
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
9
�
FENCE
--
1 I
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this aDPllenllan; that the In.
TOTAL AMOUNT DUE
T
farmatlon given In 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-
ATTENTION
APPLICATION APPROVAL
toting conetructlon; and in doing the work authorized thereby, no Person
will be employed Ia vkdallon of Na Labor Code of the Stale of Washington
THIS PERISIT
This application Is not a permit until
relatlag to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
,
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
--
s
e
ehnll be completed In ninety day.; MOVED -IN BUILDINGS shall bcom-
knowledged In space provided.
plelcd In sixmonthe.)
RE (O R AGENT) DATE SIGNED
INSPECTION
IRE O 'S 0 URE
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DEPARTMENT
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EU
CITY OF
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Check Fee
EDhiONDB
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NOTE: Applicant SBhjecl to Plan
775-2525
—
Title Penult r cork to be done on private Property ONLY.
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