660582.pdf3
UILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
;fAME toR NAME OF BUSINESS)
F
WAILMG ADDRESS
7/ R-o
TELEPtLON19 NUMBER
CITY TELEPHONE
CITY LICEN
STATE LICENSE: NUMBER
or Attach FOU
Legal Description of Property (Show beLOW
FON _KROLL MAP NO.: PERMIT
NUMBER 66058?.
DRESS
0
VACANT SITE
0 YES 0 NO
VARIANUN PiUmm� od
EGST_&�'S'T'REET R/W ............ IT- DEPICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ Fr- .......... Fr.
REMARKS
CKED BY 0
Z
I I I W
[3 YES 0 NO
RESIDENTIAL I
M
GAS
LINE
ElNEW
NON-RESIDENTIAL]
SIGN
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
FILL
PENCE
I x... Ft.)
OR
..........
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER
DWELLING
UNITS
0
7-1 A-'
/.,-: I )—e 4
rian Check No ............ . .......
BUILDING
�&ato
_Pk&� Building setbuu", abutting streets)
PLUMBING
HEAT & GAS LINE
0
PENCE
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given in 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 ragu- ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington TIUS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Umit One Year (Except DE31OLITIONS which WORIJ NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.) INSPECTION
IIGNATU OR AGENT) DEPARTMENT
CITY OF
NOTE: Applicant Subicci to Plan Chcch Fcc PR 0-1107
This Permit coven work to be done on prlvnto property ONLY,
Any construction on the pnblic domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
I
[] YES [3 NO
ation Fee Receipt No.
Fee
� ;00
0
APPLICATION APPROVAL
This application is not a permit until
signed by the Building official or bis Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DIRECTCLRIS SIGNKT�URE
DATE
FILE
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