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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BEDDNFON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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DOMAIN (CURBS, SIDEWALKS, DRIVE S. MARGUEES, ETC.) WILL REQUIRE
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:3 SEPARATE PERMISSION,
SURCHARGE
PERMIT APPLICATION: 1800AYS
STARTEDWITHIN 180DAYS
ENCR I W S
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'AP F HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
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ENG, INSPECTION FEE
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ENFORCE ANY ORDINANCE PROVISION
EIPT
RECEIPT
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SABI
NOR LIMIT IN ANY WAYTHE CITY LITY TO
TOTAL AMOUNT DUE
255
I HER EBY ACKNOWLEDGE THAT I HAVE READ THIS AP PLICATION; THAT TH E INFORMATION
APPLICATION PROVAL
GIVEN IS CORRECT, AND THAT I A T' 'OWNER OR THE DULY AUTHORIZED AGENT 01
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Thl, IPPI-1-11- 1� , 111 11jil 11,le bY the
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771-0220
REL SED, DATE
ATMNTION I
EXT/333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORGINAL-FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER GOLD -ASSESSOR
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NUMBER EJAPT#
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JAo.`D ESS
CONSTRUCTION
LID NO,
OWNE" EINAMEOFBUSINES�_
PIT NAMEISUBOIVISION NO.
I LOT N
LID FEE $
0
0
MAI 'ING ADDRESS
7;74�1'
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0
EXISTING_ PROPOSED-
0 TELEPHONE
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LINE SIZE
FT
QUI D
NO. OF FIXTURES P R
METER SIZE
Y ES
FTY Z111111
NAME
ADD
�T.LER.GNE
CITY
1..C�IE. .1
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REPAIR o
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NUMBER ELI I �G
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UNITS
DESCRIBE WORK TO Uh —
DATE
FIRE REVIE NED By I
VARtANCEOR U SHORELINE OR ADB# tNSp TION BOND
HE 'D POSTED
(:)YES E3NO
SERA E I SIGN AREA HEIGHT
Go PLETE I E EMPT ALLOW" PROPOSED ALLOWED PROPOSED
XP L T C VERAG REQI CKS(R.) PROPOSED SETBACKS (FT.)
ALL ED PROP BED FRONT SIDE RE FRONT UPSIDE REAR
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REOT) I PROVIDED1
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VALUATION I FEE
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GLAZIN� LOT SLOPE I
BUILD NG
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P umBING
VESTEDDATE
ILAN CHECK NO:
MECHANICAL
16 PERMIT COVERS WORK TO
THIS PERMIT AUTHORI oTED TH PUBLIC
PERTY Ly. NSTRUCTION ON THE
GRADINGIF11-1.
B o E ON PRIVAT P
S.
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PeRmITAPPLICATION:,S'oSoTAoRATYESD WITHIN 180 DAYS
YEAR WORK
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PERMIT LIMIT.' PROVIDED
SEE BAC.I.j,P INK PER MIT FOR MORE INFORMATION
SPEC "jS
ASSIGNS AND SUCCESORS,
F
'APPLICANT. ON BEHALF OF HIS OR HER "oU." RE'I RAII.IEES THE CII�Ac��B
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AGREETS.rNl FROM ANY
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IN PECTION FEE
IN INTEREST.
ED""'. WASHING ITS OFFICIALS EMPLOYEES. AND AGENTS
FOR DAMAGE�OF WIHATEVE� NATURE. ARISING DIRECTLY OR INDIRECTLY
THIS PERMIT SHALL NOT BE
REc IPT
PLAN CHECK DEPoS T
ALI""'
FROM THE ISSUANCE F-'T EU ;E -F EN'.
.EE.E . WAIVE OR REDUCIi A`I�ly RA20C o F ANY CITY ORDINANCE
,CG'FY OF THIS " UI
-T..' ANY RDINANCEPRovisioN
REC
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N L 60 D o E
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771-0220
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771 -0221
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PIINA
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BEEN MADE
A FINAL INSPECTION HAS 0
SECTION 1 9
FAX
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