670002.pdfY_ 97
NG DEPARTMENT I Applicant FIR
IT APPLICATION Inside Heavy Lines
S- aj.
TELE1
I 11-e
or
i
RESIDENTIAL
GAS
LINE
ADD
ALTER
E] REPAIR
LEINON-RESIDENTIAL
STON
RETAINING
WALL
PENCE
( .......... x .......... Ft.)
SWIM
POOL
ElDEMOLISH
El
1:1
EXCAVATE
OR FILL
PRE -MOVE
INSP.
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
OLL MAP NO.: PERMIT
NUMBER
o c7
SETBACK
:1 NO
JMBER I �;
EXISTING STREET R/W A'dr..FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W doev XT.
.,F>, 6cl .
�_ f
�M' ft I
TYPE CONNECTION VE BY
PERO. TEST PERMI"BER,
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
EJ YES 0-fro'_
SPECIAL INSPECTOR RNQUIRED OCCUPANCY GROUP
[:I YES W-V_0_� _477
PLAN CHECKED B
�LII.ECKED BY
valuation Fee Receipt No.
Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUNU31NG
'75
HEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
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 rogn.
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
THIS PERMIT
relating to Workmen!s Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; AIOVED-IN BUILDINGS shall be com-
pleted In six months.)
BIG WNER OR AGE�p
70� Zzw4
DA-1 SIG'ED
7
INSPECTION
DEPARTMENT
C
CITY OF
I
13RULONDS
NOTE: Applicant Subject to Plats Check, Fee
PR 6-1107
TlAs Permit coven work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquen, etc.) will require separate permission.
OU
120
"1411,
I 6�F e�q 0 V-3 S��
APPLICATION APPROVAL
This application is not a permit until
signed by the Building OfficiLd or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
_V2
FILE