750255.pdfZUSE
NUMBER i j G
ONE PERMIT 50255
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION I Imide Heavy Llnoe
JOB ^ /� V ( r /• . 1
ADDRESS
NAME (OR NAME OF BUBINEHtl) {/�/7t ��/' A
�f�
!KJ_Vf\
pFItMItlHIDLE "' ACTUAL
LOT COVERAGE. LOT COVESYAOE 1
A/V'JNaNY �° DI I/1N��'"
O �,
f
03 A1LIN0 ADDR tlB
PEIiD11Stl1BLE HEIOFIT YItGrGBEn HEIDHT
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1
�! � �/EJLE�JpaoliE
ACTUAL LOT AREA TOTAL BLnG. AHtiA
Cl
NUMMBhR
jSSS...
/.�J i`
k
/ /Q-0 / Ei
REQUIRED YARDS PROPOSED YA RUtl
REAR
OMLI
!r(,j / o
FRONT SIDE REAR FRONT .IDE
NAME
LEOA1, I.O'C VAItIANCL•' OR CONDITIONAL USE
NUMBER
ADDRESS
N
YE9 []NO YF,ItMIT
y
T.
PLANNING UEPT. APPROVAL UATE: I I
O NUMBER
< CITY
STREET R/W G
(TELEPHONE
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY $;
N/AM...,E
COMP. PLAN 8T. R/W ............FT. ............FT.
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�Q/VOf11� P�gG (✓�'
nEAIARKB ^V
C ADDRESS
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CITY T/EPHONE UMBER
u%4 u4&LICENeE
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ME'CER SI'LE SERVICE SIZE
CLEARANCE CHECKED BY
—me
O STATE HER
NUDI
CITY LICENSE NUMBER
I
I
3 7S$
I
—REMARKS OILS
' Legal Description of Property (Show Below or Attach Four Copies)
F-�J
TYPE CONNECTION I VERIFIED BY
y
I F
PERO. TEST PERMIT NUMBER V
4
ItEASARK9 m
L'
FIRE ZSIDI'E
TYPE OF CONSTRUCTION STREET IAIPItOVED
I I (3 YES ❑ NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
}�7r'
CAB
❑
❑ YES �,NO
DY
LOCATED IN THE CITY
NEW
IN RESIDENTIAL
!❑�
LINE
PLAN CII£CK THIS SITE IS
LOCAL SALES TAX
NON-RESIDENTIAL
1:1 SIGN
SHOULD BE CODED 31.04.MONDS.
ADD RETAINING
DEEfOL18H � WALL
REMARKS
47),r]/i. Q
�l
PENCEz..........FL)
)p�/C,IJIC..G wt
EXCAVATE ❑
ALTER ❑ ORFILL
PRE-INSP0" SWTM
Y r �r i%� /y-��� f
I�/IC.G "7(/rCI`e•`•T
REPAIR ❑ POOL
❑
Y�-i��rl
NUMBER OF STORIESI NUMBER OF
DWELLING �'.}+/.
UNITS tT O
NATURE OF W O E DONE
Vnluall,n FCc Receipt No.
—
Plan Check No .....................
4
BUILDI—570/�
l
I,
[0
Y PROPOSED USE
PLUMBING gag 9 , ao
U
PLOT PLAN (Indlcala B-Ildin6 embacke, abuttln6 streets)
HEAT & GAB LINE
C
FENCE
SIGN
tRETAINING
WALL
N
I
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Q Q _—
TOTAL AMOUNT DUE
I hereby nek—ledge that I have read this application: that the In-
formation given le correct: and that I am the owner, or the duly author -
,zed ,gent of the Owner. I agree to comply with city and state law. reg--
ATTENTION APPLICATION APPROVAL
,at,.. conetructlon: and In doing the work authorized thereby, no person
th e Labor Code of the Stale of Washington THIS PEnbm This application is not a permit until
will be employed Ia ,.,all.. of
,...U.. to Workmen's Compensation Insurance.
AUTHORIZES signed by the Building Official or his Dep-
,
ONLY THE ut and fees are paid, and receipt is ac -
y'
NOTE: Permit limit One Year (Except DEMOL TIONSwhich WORK NOTED
be knowledged in space provided.
shall be completed In nI.,ty days: MOVED -IN BUILDINGS .hell cam-
pleted In six months.) INSPECTION
SIO ATUIt' IVNEit OR AGENT) DATE SIGNED DIRECTOR' GNA
DEPARTMENT
OF
CITY O
fjjrjj�F
EDTY DATE
._
NOTE: hplica[t Subject to P►dD Check Fre
775-2525 Lf�
Tile Perinit cu)'en work 1- bo done on private property ONLY.
Any construction on the public domain (curbs, eldewalks• dNvew►y.,
FILE
marquees, el C.) n'lll require erparnle pernllsel.n.
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