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PERMIT No,
N? 211
O .+I R
MAIN
BUILDING
ADDRESS _ L
PHONE
TYPE OF CONSTRUCTION
UILOER
ADDRESS
-h Q
I I
SIZE
OF
�
C A
ARCHITECT
ACCESSORY
BUILDING
ADDRESS
AREA
FT. r 8Q. FT.
.q
/
�j to 4 /V
JOB
STREET O
" NUMBER
Ile
ADDRESS
EXISTING BUILDING AREA----------- - --
� 0
USE ZONE
+�
LEGAL -S 1 Ri
: ,� lV �j- / JV
A
LOT SIZE
LOT AREA
N I
1 �
�'f L
He ?. 4 A
LOT AREA OCCUPIED
LOT 61 ,�
BLOCK
YARDS
MAIN
SET BACK
SIDE YARD
REAR YARD
NEAREST
ACCESSORY
SET BACK
810E YARD
REAR YARD
NEAREST
DISTANCETO
BUILDING
FINISH
BUILDING
BUILDING
BUILDING
PROPERTY LINES
HOW
BASEMENT
SIZE
FT.
AS )
HEATED
fa ASG (]F WnRK
J
REMARKS, DESCRIPTION OF ANY WORK NOT COVERED ABOVE
WARNING Notify Building Department by Street Address and Permit Number when ready for inspection. Work must not be
co vered before inspection and OK for covering has been given by Inspector in writing on Permit Placard.
I hereby acknowledge that I have read this application and state that the above is correct and I further agree
to comply with all City Ordinances, State Laws, and lawful orders of the Building Inspector go rning ilding con-
struction. ..-
Written Authorization of the owner must be pre-
sented when work is done by occupant or lessor. OWNER DT
PERMIT FEES.. (THIS SPACE FOR BUILDING DEPARTMENT USE ONLY)
0.0
1 Z Q (9 (► HOUSE 8 OTHER MI
HOUSES GARAGES A O " ARAGE i e2 BUILDINGS i FEES i
9 tp BE IT y / /�/
BOND NO.— TOTAL FEES i BY ATE ,f�Lit�/
NOTICEt THIS PERMIT DOES NOT COVER PLUMBING, SEWER, OR WIRING INSTALLATION,
PERMIT PLACARD MUST BE POSTED ON THE WORK
MAIN
BUILDING
WIDTH DEPTH
Gq1y,. �/
FT, x
AREA
_.
FT. .. 9 e 80. FT.
TYPE OF CONSTRUCTION
-h Q
SIZE
OF
BUILDING
ACCESSORY
BUILDING
WIDTH DEPTH
/ yr FT. X
.J
AREA
FT. r 8Q. FT.
.q
/
1�
60. FT,
Ile
EXISTING BUILDING AREA----------- - --
� 0
60. FT.
TOTAL AREA OCCUPIED,
LOT AREA
LOT AREA OCCUPIED
LOT COVERAGE
Qy
80. FT. '
fir/ � / S 80. PT,
LJ
/U
EXTERIOR
FINISH
"'�
OCCUPANCY
TO BE USED
HOW
BASEMENT
SIZE
FT.
AS )
HEATED
07 $26 AM
ROOMS
/
TOTAL ,
BED
ROOMS 3
BATH6 ,
LIVING /
L•O
COMBO
DEN
KITCHEN /
NOOK ,
. •D _ ATT.
NOOK� DET.
❑
Gb
VALUATION OF
HOUSES
GARAGE i
HOUSE .ATT. GARAGE i
OTHER i
A L LIMPROVEMENTS
Q
FOUNDATION OK
FRAMING OK
FINAL INSPECTION
J
REMARKS, DESCRIPTION OF ANY WORK NOT COVERED ABOVE
WARNING Notify Building Department by Street Address and Permit Number when ready for inspection. Work must not be
co vered before inspection and OK for covering has been given by Inspector in writing on Permit Placard.
I hereby acknowledge that I have read this application and state that the above is correct and I further agree
to comply with all City Ordinances, State Laws, and lawful orders of the Building Inspector go rning ilding con-
struction. ..-
Written Authorization of the owner must be pre-
sented when work is done by occupant or lessor. OWNER DT
PERMIT FEES.. (THIS SPACE FOR BUILDING DEPARTMENT USE ONLY)
0.0
1 Z Q (9 (► HOUSE 8 OTHER MI
HOUSES GARAGES A O " ARAGE i e2 BUILDINGS i FEES i
9 tp BE IT y / /�/
BOND NO.— TOTAL FEES i BY ATE ,f�Lit�/
NOTICEt THIS PERMIT DOES NOT COVER PLUMBING, SEWER, OR WIRING INSTALLATION,
PERMIT PLACARD MUST BE POSTED ON THE WORK
SEA , TTL9-KING COUt( DEPARTMENT OF PUBLIC HEALT9 1XVISON OF SAWTA�ION
Room 904, Public Safety Sull6li"
APPLICATION FOR BUILDING SITE APPROVAL
(Submit in Triplicate)
(1118 accompanies the building permit application and is prerequisite to the ivausace of the Sepde Tank
Permit.)
Location of Property-Street A:ddress ...... ....... 5 .. ?...7 ......
. (:/
.� Addition or .... )? 4 P-(E G ...... Lot .... 6.6 .......... Block
Type of Building: New ............ Existing ... ............. Single-family residence? ...
Basement ................ Other (Specify) ... ........................ .......... . . ......................
NOTE: This application may be submitted to the main office at 904 Public Safety Building, or, -for prompter
service, directly.to the branch office having jurisdiction in the area in which the property is located. To
contact District Sanitarians by telephone, -place phone calls before 9:30 A.M.
Seattle Office 904 Public Safety Building JUniper 3.2065'
North End 15272 - 15th Northeast EMerson 3-4765
PAstside 15607 N.E. Bellevue-Redmond Road, Bellevue TUcker 5.1278
Southeast 812 "E" Street, Renton ALpine 5.3496
Southwest 1082 S.W. CHerfy 4-6400
Owner
Address
hone (.:f
.......... _...
Builder ..!5ig?T ..................... ....................... ... I ........................... . ......................................... Phone
Designer .... ...... ........... Address ..X_50...3 z& ............. Phone _. Qf-R.
Soil Log Hole No. I ....... ....... pp ...7
. .....
.... . .............. I .......... .................. 1$ ......
.... . ............................................. ......... $ .............. ....................................
4C O d
Soil Log Hole No. 2 e.0!F1,oMJ;..7* ................................. ...................... ..........
................................ I .......... .... ... I ............ I ............................... I I ...... I .... .... ..................................................................................... I— ........... I .............................
SoilLog Hole No- 3 ....................... .................................. ............................................. ........................................................... ........ .... . . ..
....................... I ........ .... ........ I ............................ I ............................ I ..... 11.111 ...... ....... ... ............................ I ......... ... ............... I ........ I ........... ..... . _...
Soil Log Hole No. 4 ........................................ ................................................... ............................................. ...... .......... . ......................... .
».. . .............. 11 .. . ....... I ... I ................... ... I ... ........... I ..... I I ... I ....... ...... I ..................... 1 ...... I ............................. I ...................................................... ... ......
Elevation of Water Table, if encountered. (Distance from ground surface) /`Q ......
Give estimated difference in elevation between high and low points on lot in feet ....
.................................... 1. ...................
Percolation
Test Hol No. I- Average rate ( ;?4r ............. (Fall in minutes-per-in. bottom-6" of test hole)
No. 2- #1 it ........ ?* .............. of to of pp to op. of to 0► op
No. 3-
No. 4- to to op to $9 0 p p I op pp to , so of
No. 5- it ............ —1 ...... I ...... I " op it of ►►
N 6- to pp pp to to op
(For additional remarks or comments attach h I �_�trlpli catel
rd'verse side of application)
Signature - Designer ,
DO NOT WRITE BELOW
artmen
I p 0 ? to 9$ 0 0
I I to I I I t of
ze unused spaces around drawing on
Date
Accepted ........_ ...................... »............... Not Accepted .............................. ... ....... ...... . ........................ .................... . ................
Date Data Health D4partment saaltall"
S-AP-110 Rev. 6/10/$8
Cal I a. to. a
CITY OF TUKWILA
WASHINGTON
APPLICATION FOR PERMIT
b 0 /V5 D 7 S h ereby applies for
(print or type name in full)
�'`
permission to , ,C,. W p A
(describe in full activities to be carried out)
(do not write on the back of this application if additional space
is required use additional application forms]
Applicant hereby agrees to carry out all activities described on'this application in com-
pliance with all applicable City of Tukwila ordinances, state and federal laws; and to
allow inspections to be made by authorized inspectors.
address where activities are to be
carried out) (signature of applicant)
(mailing address of applicant)
(date of application)