670136.pdfr
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BUILDING DEPARTMENT I nn�uoBntFiu
PERMIT APPLICATION IB�'d° HOAYf I.1D°s
NAME (OR NAIiI� OS BUSDVEBS)
�vD«Y � . l��s�£y
�b ae � �,�► uc
9'ao 7 D��/n� PI c I%c�
TY T LEPiiONE M ER
E ism o nl DS � c� �'—s �.,
/�, RESIDENTIAL
❑ NEW � NON-RESIDENTIAL
ADD ❑DEMOLIt�
ALTER ❑ EXCFSLL
.REPAIR I l PRE-LSOVE
' l INSP.
6A8
LINE
BION
RETAINING
WALL
FENCE // /
�j SWIM
'— ` POOL
T
N
I heroDY acknowled[e thet I have read tbla nDDllcatlm; that the tn-
formatlon given U correct; and that I am the owner, or the duly mthor-
laed agent of the owner. I a[ree to comDll with city and date laws rogu-
Iatln6 Donatructlon; and !n doln6 the work suthorlud tberoby, no person
will De employed in v(olatlon of the Lahr Code of the State o! Waebin[ton
elating to Workmen's gompeaaatlon Ineuranoe.
NOTE: Permit Limit One Year (Except DE\IOLITIONB which
shall be completed 1n ninety days; MOVED -IN DUILDINOB aba11 be com-
pleted In al= mmths.) �_
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is /y�
NOTE: Applicant Subject to Plan Check Fec
This Permit coven work to be done an Drlvote property ONLY.
An7 eoost�Q �� t6ee D wW 8� n,eDarnte Perm�I,alondrltrownYb
EXISTING STREET R/W ............FT.
COafP. PLAN ST. R/W ............FT.
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NO
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DEPTCIENCY TRIG PROPERTY t7 f I_ -
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CSECKED BY
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LANCE I CRmCKED BY �.�
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'ERMIT NVMBER � .1 _..
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ON STREET D.>PROV14Il � _�
�.YEB 0 NO
JCOUPANQY GROUP � '� �..' �
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