650257.pdfPLAN FILE NUMBER BUILDING
Fill PERMIT 65 U2.571
1,0011ding Permit Application 1"n S'l Top ll'e a'v' NUMBER
y Lines
NAME (OR NAME OF BUSINESS) JOB ADDRESS
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11AILANG ADDRESS SIDE YARD SET BACK REAR YARD
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SIDE YARD
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TBLE USE ZONE MAP NUMBER
PHONE NUMB VACANT SITE
0 YES NO
BUZ DII;G j FtEA LOT AREA VARIANCE NUMBER
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HE
,IGY
as aT ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
TELEPHONE NUMBER
RESS Encroachment Permit PE NUMBER STREET GRADE CHECK
Required
of BF
0 YES NO
PHONE NUMBER METER SIZE BE BY
RVICE SIZE CLEARANCE CHECKED
3ER CITY LICENSE NUMBER REMARKS
BL40CK TRACT
LOT
3 7
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TYPE CONNECT N VERIFIED BY
99
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f PERART'NUMBER
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES No
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
0 YES ff-1�110� =Z:
PLAN CHECKED BY
WORK TO B E DONE
Or 131:009. PIERIBLOG. TOTAL FSK
-4-6 x in Lae BUILDING
P VALUATION
ee, Place 4 t4aberpoli BUILDING PERMIT
If 11)17 2 FED 0
NUMBER OF -STOODS
NEW E] DEMOLISH PLUMBING
ADD 3 PERMIT FEE d,
I I HEAT & GAS LINE
I PZ71 4
ALTER RESIDENTIA.L NUMBER OF PERMIT FEE
DWELLJNG I
DEMOLITION
REPAIR NON-REBIDENTIAL I UNITS 5 PERMIT FEE
PROPOSED USE I
:5 1cle- nce 6 AMOUNT DUE
Owner.
I hereby acknowledge that I have read this application; that the In- ATTENTION A
formation given Is correct; and that I am the owner, or the duly author- PPLICATION APPROVAL
Ized agent of the owner. I agree to comply with city and state laws regu- THIS PER511T This application is not a permit until
— 6
luting construction; and In doing the work authorized thereby, no person
AUTHORIZES signed by the Director of Building Inspec-
will be employed In violation of the Labor Code of the State of Washington ONLY THE
relating to Workmen's Compensation Insurance. WORK NOTED tion, or his deputy; and feen are paid, and
receipt Is acknowledged In space provided.
NOTE: PERMIT LIMIT ONE YEAR INSPECTION
SIGNATURE (OWNER OR AGENT) VXX SIGNED DIRECTOWB SIGNATURE
DEPARTMENT
<5p CITY OF
MMONDS DATW,
PLOT PLAN CHECK & APPROVED
PR 0-1101
FILE
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