670217.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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CITY
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ADDRESS
CITY
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STATE LICENSE NUMBER
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B_'�ESIDENTIA
GAS
LINE
NON-RESIDI TIAL
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SIGN
RETAINING
WALL
0
DEMOLISH
EXCAVATE
PENCE
ALTER
OR FILL
( x Ft.)
REPAIR
PRE-11OVE
INSP.
El
.......... ..........
SWIM
POOL
ES
NUMBER OF
DWELLING
UNITS
D ON KROLL MAP NO-:
PERMIT
1 NUMBER
670217
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)DRESS
YARD BET13ACK
STMNUT SETBACK
REAR YARD SETBACK
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6ONE
LOT AREA
VACANT SITE
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E] YES 13 No
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I VARIANrE NUME ow
WOW MI
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EXISTING STREET n/W-&.-... ... FT. DEFICIENCY TBIS PROPERTY
COUP. PLAN ST. R/W ... FT.
REM&RKS
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METER SIZE SERVICE SIZ Or BY
A E CLEARANCE LZ
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Cj YES
Plan Check No .....................
PROPOSEITUSE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets) PLUMBING
HEAT & GAS LINE
A/
FENCE
SIGN
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.
lzed agent of the owner. I agree to comply with city and state lawa regu- 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
ONMY THE
NOTE: Permit Limit One Year (Except DE31OLITIONS which WORK NOTED
shall be completed In ninety days; i%lOVED4N BUILDINGS shall be com-
pleted in all months.)
JIGNATUIM _(OWNER OR AGEN DATE S GNED INSPECTION
DEPARTMENT
CITY OF
NOTE: Applicant Sitbject to Plait Check Fec ED31ONDS
1111 6-1107
This rermit covers work to be done on private property ONLY.
Any construction on the pubtle domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
YES 0
Fee
,Z, 00
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No.
LF-r"e-901 �?*?D
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged In space provided.
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