670182.pdfot
BUILDING DEPART M ENT Applicant Fill
P M PP 15 A!11 Inside Heavy Lines
ERMIT APPLICATION
7
N ME 0 A 0 B
AME (OR NAME OF BUSINESS)
EBB
AD
14 FMAILING XUDRESS
HunuiNG
PERMIT 670182
NUMBER
I:--) ?) E NUMBER [3 YES C3 NO 1Z
CITY BUILDLNU AltzA _'VFAA_RTANCE NUMBER
C
NAME PLOT PLAN APPROVED
REMARKS Is
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R ADDRE138 METER SIZE I SERVICE SIZE rLEARANCE CHECKED BY fa
9 G 0 �k�103 =�,± W 99
I CITY TIG"j,1j1U14j1;_f+qjMBER REMARKS
10 E, C) I m4i-�Id 19
or Attach Four Cop I
PERC. TEST PERMIT NUMISIGA
[] YES I] NO
[] YES [] NO
BUILDING
WORK TO BE ONE I VALUATION Z
BUILDING PERMIT
U 2 FEE 41
PLUMBING
Z L�-- t 4- 4c) 3 PERMIT FEE
0 HEAT & GAS LINE
4 PERMIT FEE 5
NEW STON NUMBER OF STORIES SIGN PERMIT
1 5 FEE
ADD DEMOLIS El PENCE DEMOLITION
RESIDENTIAL UMBER OF 6 PERMIT FEE
ALTER NWELLING PLAN CHECK
REPAIRI NON-RESIDENTIAL I UNITS 7 FEE
8 AMOUNT DUE
I hereby acknowledge that I have read this application; that the In- ATTENTION APPLICATION APPROVAL
formation given Is correct; and that I am the owner, gr the duly author-
Ized agent of the owner. I agree to comply With city and state laws regu- Tilts PERMIT This application is not a permit until
lating construction; and In doing the work authorized thereby, no person AUTHORIZE8 signed by the Director of Building Inspec-
will be employed In violation of the Labor Code of the State of Washington ONLY THE
relating to Workman's Compensation Insurance. WORK NOTED tion, or his deputy; and fees are paid, and
(Except Demolitions which shall receipt is acknowledged In space provided.
NOTE: Permit Limit one Year be completed in ninety days.)
INSPECTION
SIGNAT JRE (OWNER 05 AGENT) I DATE SIGNED REOT IGNA';JJRE
a7s
DEPARTMENT
CITY OF DATE
LLL EDIVIONDS
NOTE: Applicant Subjcct to Plan Cbeck- Fee PR 6.1107
his Perndt covers work to be done an private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways, FILE,
marquees, etc.) will require separate permission.
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