670113.pdf6
BUILDING DEPARTMENT I Applicant Fin
PERMIT APPLICATION inside Heavy Lines
NAMIC (OR NAME OF BUSINESS)
L 6 1?/? V /, . C �)
MAILING ADDRESN 7L j
M
CITY TELEPHONE xii.IMBER
W
o /t/ 0 S I / f �_ __ �z Z12--
4-3 0- /
PERMIT
NUMBER
6-101 13
BACK
YES NO
VARIANCE NUMBER ow
PLOT PLAN APPROVED
ADDIMBS
STREET R/W
-ICIENCY THIS PROPERTY
PARER EXISTING STREET R/W ............ FT. DRIP
aIT—Y
COMP. PLAN ST. R/W ............ FT. ....... ....
REMARKS
14AME
CHECKED BY
ADDRESS
CITY METER SIZE SERVICE SIZE CLEARANCE CHECKED By
TELEPHONE NUMBER
REM.ARK5
STATE LICENSE RU—MBER CITY LICENSE NUMBER
TYPE CONNECTION VERIFIED BY
Legal Description Of Property (Show Below or Attach Four Copies)
PERC. TEST PERMIT NUMBER
L 0 7
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES 13 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES NO
PLAN CHECKED BY
GAS
NEW RESIDENTIAL LINE REMARKS
NON-RESIDENTIAL SIGN
RETAINING
DEMOLISH WALL
E]
ALTER EXCAVATE PENCE
El OR FILL .......... x .......... Ft.)
REPAIR PRE -MOVE SWIM
INSP. POOL
NUMBER OF STORIE13 NUMBER OF
DWELLING
UNITS
NATURE OF W K TO BE DONE
Z Valuation Fee Receipt No.
0 C/ Plan Check No ............ . .......
PROPOSED USE
BUILDING
Q PLOT PLAN (Indicate Building setbacks, abutting streets) PLUMBING
0 0
HEAT & GAS LINE
FENCE
t SIGN
N
RETAINING WALL
SWIM14ING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In- TOTAL A31OUNT DUE
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-
ATTENTION
lating construction; and fit doing the work authorized thereby, no person APPLICATION APPROVAL
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT This application is not a permit until
reloUng to Workman's Compensation Insurance. AUTHORIZES
ONLY THE signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt Is ac-
sball be completed In ninety days; MOVED4N BUILDINGS shall be com- knowledged in space provided.
pleted In six months.)
81GNATLIRE (OWNER 0,11 'NT) ATE SIGNED INSPECTION DIRECT R'S SIONA U
I/ DEPARTMENT
CITY OF
62211EMML 1� 5�
V 77 - r-J"MONDS
NOTE: Applicant Subject to Plait Check Fee
This Permit coven work to be done on private property ONLY. PR (1-1107
Any construction on the public domain (enrlm, sidewalks, driveways,
marquees, etc.) will require separate permission. F FILE
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