1981, 03-24 Permit: 80B-3560 Inspect INSPECTION Rix=
ADOESS
DATE REMARKS
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ORTM4 KANE,WASHINGTON 98160/IbPOBACR466-3676
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APPLICANT: COMPLETE NUMBER F! SPACES PRESS Ifr,R)TO MAKE 3 COPIES
NT PERMIT
NUMBER
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1
+5600
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t. e 611/0 /O.zQvC(idL LEGAL DESCRIPTION—SEE ATTACHED +5600 15LOT OCR SUBDIVISION PARCEL NUMBER/51/S37-/../.4-#4i
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OWNER PRONE
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3. A•�/M)HIa.f.," ��OgL/,(i/J,L.y(� �,�-.70,S.Z /"d rJ I74K..5- s/nR to o w wv,TCA •000 0
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E,6 O /O . RCl,ae-T6At4 c o 9206 min z.s 15outh 76 I as//G. IWO PZP I,:
2r on oneCla,anutlon I L-C,3-80
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nerd ��yaize of Pawl. z o` •:u d, >i 6479.
n 1402/P. '`f- 4Fx sif u_. 9Q2/1. 'V-t-A �`Mc Dv.. ❑N. U Corp. .,
DESIGNER
6. pHDNES/�It`�- .IIUI`AO. �P sl_p.
ADDRESS DP
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tler
CHANGE OF USE FROM �n' r Pp.=-oor .,...•/-
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TO e f DeecMk''��N+�✓:IR�a�? I Basement
Baths No.
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T. WORIp SLG. ❑FLMa. ❑mE N. ❑m H ❑Poo( U OTHER NO.CERTIFICATE/ � n Of Ow a b
F� E of EXEMPTION epom yv�Re
D45 R E RN 'urn'
nu f on(wrul
9. + /y am L''." FEES COLLECTED
iECTRIC WATER SEWER Owners: USE COOS
9 VgLUAT1ora UTILITIES Pool,0Private X_ Single j
I hereby certify that I have 1arld:n I I rirl 1 Iu 'd the"NI I I 1.,.,...srns eluded D
reverseon s dc,and k aw 1 n, .li I 1 cor AI sCl I' Bove Ing the r -
b.
rypeofwork will be COMElied with whether I d eI I I he gra tt nq II ,hoes.,or presume Buildup V
to give authority to violate or cancel the prnvl..ons of.II ow... I .I local law rrnpil:.Inm construction or the
performance of canstmction.SEE REVERSE SIDE FOR REQUIRED INSPECTIONS Plumbing
DOTE or APPLICATION
,',I`r L APPROVALS '3 SPECIAL CONDITIONS:
NAME
(Cl:PnI'AN _ t,fuap� EWE .
SPECIAL
DATE
' /f.(.C1M.QQ�(�/( fl
0/•a/0--8/ Pim Check
PF a _ /Y,5._ ?-6. az-e.c.C....fL...1.,V.. 1/ BEM
•,,C.4...2Mobile Name
•
Enpina.r • Other ISeeclIc
I them
J,.m _r TOTAL 9 VI.
�" r WN EN MACHINE VALOr TEO IN THIS SPACE