16080 SW QUEEN VICTORIA PL S
BUILDING PERMIT APPLICATION T1Ati`{. DATE to h , , 19
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
OWNERf �i2„�,,. ` / 1 ADDRESS /467650 t BUILDER PHONE
tili:� tta, / ' ENGINEER
gl,'ILDERL, ✓/ i /.. ARCHITECT DESIGNER
STRUCTURE ONEW /REMODEL ❑ADDITION REPAIR ORENEWAL ❑FIRE DAMAGE ❑DEMOLITION
ESIDENCE C COMM DEDUCATIONAL ❑GOV'T ❑RELIGIOUS DPATIO 0 CAR PORT GARAGE ❑STORAGE OSLAB ❑FENCE
BOND ❑MOVING OCONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED DSIGNS
OCCUPANCY LAND USE ZONE BLDG.TYPE IRE ZONE_ PLAN CH CK BY HEAT ,
4/2.111/...04-trfriv_efiM *
CrLildj4"7-1 -
OCC. LOAD FLOOR LOAD HEIGHT NO.STORIES AREA VALUE AV)
BUILDING DEPARTMENT i SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit 11 it J I - iT
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS 11 CONTAINED IN THE BUILDING CODE, ZONING
Plan Check Ij REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
II� WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATtONS AND IN COMPLIANCE WITH
Recording 11 ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
'1 RESTRICTIVE COVENANTS. CONTRACTOR AP. .JB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
%State ,1 4/14
LICENSE. SEPARATE PERMITS REQUIRED FOR M
,HER, PLUMBING AND HEATING.
Total Ii /
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BY ; • ! <«
I' APPLICANT u4 AGEra., r
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I
Approved Il ! Receipt No. / ���/ � ' Y-� 7�
! ADDRESS PH NE
•
KING-C111- STRUCTURAL AL CHANGE REQUEST
MemberA,e-12l-kuv2--_,/ei -,576y,-- Date f_— 9 77
•
Address /‘ 6 .,f1e ft� �' Phone (/2) ,-- ,5-677
TYPE OF CHANGE
(Patio Cover, Room, Fence, etc.)
PLAN: DIT MENSI ONALAFD MATERIAL DETAILS
•y -
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.
)4) A building permit must be obtained from the city for all improvements costing over
500.00
Date Notified . _ala KCCA Board of Directors
President
Date to be Completed Approved Vice President
Final Inspection Disallowed (Reasons)
1./# -1 1 l - �e C