750167.pdfe
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BUILDING DEPARTMENT I Appilcant Fill ZONE G NUMBER 750 167
PERMIT APPLICATION Inside Heavy Lines ,oB
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NA (OR NAME OF BU82NE86) ADDRESS ��� iv rJri �(
r� PEItAfI� ACTUAL (p
�) �� IJ Q.�DS LOT COVERAGE 311 LOT COVERAGE
MAILING ADDRESS PERM1tltlIBLE HEIOH L PROPOSED EIGHT
V
O CI TELEPHONE NUMBER ACTUAL I T� AREA ,{� TOTAL/BLD%�AAEA zt
Nhlw000 kJF '7 e-y1z7 r P S
REQUIRED YARDS PROPOSED YARDS 6
NAM T FRONBIDE REAR FRONT BIDE REAR i
ao' 5' 15' -o' 2d.
ADDRESS L 6 L LOT VARIANCE OR CON TIONAL UW
N YES NO PERMIT NUMBER
DEPT,
PLANNING V DAT
V _
CITY TELEPHONE NUMIIFH
6TIIEET R/{V �
EXISTING STREET R/ DEFICIENCY THIS PROPERTY
NAME
COMP. PLAN ST. R/{ FT. ...L�%...FT. W
C ADDREtleD�u�2 RDMARFIS Driveway slopes not to exceed those o '
indicated on Standard Dwg. No. 103
x
CHECKED BY
F CITY TELEPHONE NUMBER 11
V METER SIZE �SERVICE SIZE I CLEARANCE CHEW. I Y
STATE LICENSE NUMBER CITY LICENSE NUMBER N
REMARKS
Legal Description
yOf Property (Show Below or Attach Four Copies)
•SDeere,. a
OT It3 Fi-Ai VMS T�� TYPE CONNECTION I VERIFIED BY
i
O C `
t`V l ] I� ti � PL•'RC. TEST PERM1 sfBER Id
n
REMARKS � �I
a I
1
.�i FIRE ZONE I TYPE 0TRUCTIOIJ/N�
I STREET IMPROVED I
J/�/•4/,�/
(] YES No
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUg j
RESIDENTIAL CAB ❑ YES 'M NO /{/• �� /
NEW LINE PLAN CH` eD Y THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL F_]SIGN J 0 ED BE CODED 3104 SALES TAX
ADD ❑ DEMOLISH ❑ RETAINING REMARKS
WALL
ALTER ❑ OR FILL ❑ FENCEX.. Ft.)
ElREPAIR ElSPaLOVE O POOLE
NUMBICH OP STORlkBNUa1HER OF
DIG
WELLN
U
NITS
NATURE OF W RK TO HE DONE
Valuation Eco Receipt No. _
Plan Check
` N BUILDING d) / •QQ I f
Y
PROPOSED USE •�% 1/f, J( 2da OQ PLUMBING . !,
PLOT PLAN (Indlcnta Building setbacks, abutting streets) HEAT & GAS LINE
FENCE
i
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE-MOVE INSPECTION
EXCAVATION OR FILL
'
I hereby acknowledge that I have rand this application; that the In. TOTAL AMOUNT DUE ='
formation given Ie correct; and that I am the owner, or the duly ..the,
lzedall agent of the owner. 1 doingreeg
to a Work
with elly and state laws ergo- ATTENTION APPLICATION APPROVAL
inting conetntetlon; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code or the State of Washington THIS PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DE51OLITIONS which ONLY TILE Ut and fees are paid, and receipt is ac-
{YORK NOTED yi P
shall be completed In ninety days; MOVED-IN BUILDINGS shall be cone- knowledged in space provided.
pleted In six months.) ,
ATURE (OWNER O AGENT) DAT SIGN D INSPECTION DIRECTO e16
(J\ DEPARTMENT
7 Lm CITY OF
NOTE: Applicant Subject to Ffdn Check Fee EDDIONDS DATE
Tide Permit cv— Work to bo done on private775-2525
Droperly ONLY.
Any rnnetruelion an Uie public domain Iru rb., sidrwnl ke, drlven'nye,
�ruui'•r, etr.i ��ill reuulra relutrate uder:c¢,I F[Lf•.
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