660505.pdfBUILDING DEPARTMENT Applicant MR
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
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MAILING ADDRESS
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CITY LEPHONE NUMBER
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NAME
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NE NUMB&
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B LICENSE NUMBER CITY LICENSE NUMI
Description of Property (Snow Below or Attach Four Copies)
e_ Y_ (rc.,
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ZONE
PERMIT 660
NUMBER
RIM
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0 NO
U—M—BEa
REMARKS
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E SIZE
CLEARANCE CH
�ny
09
R&ARKS
TYPE CONNECTION
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04
PERC. TEST
NUMBER 01" STORIE
NEW SIGN
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Q ADD I DEMOLISH R LNCE
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0 ALTER L4�j RESIDENTIAL
VVrElt or
LLING
REPAIR NON-RESIDENTIAL I UNITS
PROPOSED USE
I hereby acknowledge that I have read this application; that the in-
formation given is correct: and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with City and state laws regu-
lating construction; and In doing the work authorized thereby, no person
will be empl= In V, d1al of e Labor Code of the State of Washington
lating to a Cc pen,T
rel au,, Insurance.
(Except Demolitions which shall
NOTE: Pe;441000)e Year be completed In ninety days.)
I
A DAT SIGNED
BI U 0' _,VOR JOENT) L
0005VOR E" lt.Je-r -7 L/—A
V
NOTE: Applicant Subject to Plan Check Fee
Thin Permit covers work I, in! done on privule property ONLY.
Any cojistraction on the public domnin (curbs, sidewalks, drivewaym,
marquees, etc.) w1il require separate permission.
OF
[j NO
[] YES W6__ I �r
BUILDING
VALUATION
Z
2
BUILDING PERMIT
FEE
3
PLUMBING
PERMIT FEE
19
4
HEAT & GAS LINE
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
TIIIS PER1,%I1T
This application is not a permit until
AUTHOUIZES
signed by the Director Of Building Inspec-
ONLY THE
tion, or his deputy; and fees are paid, and
WORK NOTED
receipt is aelmowledged in space provided.
INSPECTION
DIRECTOR'S SIGNATU
DEPARTMENT
CITY OF
7
ED31ONDS
Pit 0-1107
FILE
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