1980, 03-04 Permit 80-1779 GarageAPPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
1.
JOB ADDRESS
Ig �
2. 3. OWr` j"I L{�I Re j1,VI IAH
"
LOT
BLOCK
SUBDIVISION
4.
5' ADDRESS
ADCO2S7 NO- rtct,ik
O TRACTO
ADDRESS
DESIGNER
CHANGE OF USE FROM
6.
TYPE
7, OF
WORK
PHONE
`24--g19�
PHONE
PHONE
ZI P
TO
d,/NEW ❑ ALT. ❑ AD'N. ❑ RPL. El MVE.
al BLD. ❑ PLMB. ❑ MECH: ❑ M.H. ❑ POOL
❑ OTHER
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S I -3 7)i�
-
I� -r 5 ! �
Require Set Backs i Feet
North South East 7 ° West
Size of Parcel
pox 1b
Type Const.
Valuation
DWL Area
Split Entry
Occupancy
Basement Area
Zone Classification
Sprinklered
❑Yes DNo ❑ Req'd.
50
Building ea in Sq. Ft.
Ga age Area
Storage
Split Level Rancher
DESCRIBE WORK
l
,17_0.>`2-4C
E ECTRIC
VALUATION
9. ,Z`2`62
Source
of
Utilities
GAS
No. Baths
No. Floors
CERTIFICATE
of EXEMPTION
No. Rooms
Rec. Room
Req'd. Rec'd.
WATER
SEWER
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. o ,
DATE . "' 3 ` ZJCJ SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
rci
SPECIAL CONDITIONS:
Gckifr-N G�
C I — r6 c./2/e2
ruNk
HAIL- i o cam)`r ev
DATE OFFICIAL
APPROVED FOR ISSUANCE
Not Req'd.
FEES COLLECTED
Single $
Building `56
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL $
DATE
02* *38.00
*38.00
*38008
E *0.00
1691-2
03-03-80
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
03.='04-'8r0` 177,95 *38,0021---'
" 7,7 ID
13ik 12- 14-
• paiz.
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