15745 SW QUEEN VICTORIA PL �1 (��} +��5��� �]� ! APPLICATION
^� n/� �t CITY O F
5!x'1 iJli�9l. 4.- s f� r1 �e_1� T� �? T G 1¢ �.. DATE 1 19 T c71 —
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOW I AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS.. OWNER PHONE ,
diOWNER ADDRESS I 5 Q..1.4.17-424(.4-47A‹ BUILDER PHONE
ENGINEER
aS;fLDFR2J2IJ' 1441Y7n./ ARCHITECT DESIGNER
STRUCTURE :NEW n REMODEL ❑ADDITION REPAIR RENEWAL OFIRE DAMAGE ODEMOLITION
JESIDENCEDCOMMEDUCATIONALGOVT, 'T PRELIGIOUS DPATIO OCAR PORT OGARAGE ❑ STORAGE I:SLAB ❑FENCE
OBOND ❑MOVING OCONDITIONAL USE ❑DESIGN REVIEW OCOUNCIL APPROVED ❑SIGNS
OCCUPANCY LAND USE 70NE BLDG.TYPE FIRE ON PL N CHECK BY HEAT
(P- - ti .Gc/A(r 4d t4 t ,/ 1 a
? .0._...)29-401Y - '' j
OCC LOAD FLOOR LOAD HEIGHT NO.STORIES AREA VALUE 9'9
C BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit
tI THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
IPlan Check i; REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
l WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
' Recording II ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AJR CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%State �� 1.0 A .LICENSE. SEPARATE PERMITS REQUIRED FOR .vER, PLUMBING AND HEATING.
1,
Total it 10. /IC; 1 t_ •
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- j APPLICANT AGEN
.. I Approved i I Receipt No.
ADDRESS PHONE
KING CTiY-vTRUCTURAL-_CHANGE-.REQUEST
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Member , T,Itet.. z� Q-,. ll_e__- —( Date 7 / 7 --- 7 7
_39 - 6 631
Address 4/_. -7 $4.5 Phone 4
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TYPE OF CHANGE
(Patio Cover, Room, Fence, etc.)
PLAN: DIMENSIONAL AND MATERIAL DETAILS
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-
Note:
1) Adjacent property owners will be informed of the requested change.
2) If there is an objection, the objection, but not the name of the objector, will
be given to the member asking for the change.
3) The Board of Directors of the Civic Association will review the plans and property
for approval or disapproval and compliance with the stated restrictions.
I ) A building permit must be obtained from the city for all improvements costing over
500.00
Date Notified KCCA Board of Directors
- President
Date to be Completed Approved Vice President
Final Inspection Disallowed (Reasons)
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