670258.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
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MAILING ADDRESS
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Applicant Fill
Inside Heavy Lines
CITY PHPJ�gj��p E51�
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NAME
ADDRESS
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CITY TELEPHONE NUMBER
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NAME
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ADDRE88
Zl-iD4 lo-L - TELEPHONE NUMBER
STATE LICENSE NUMBER CITY LICENSE NUMBE
1022S - 0 /_ * to 0 Z_ I
ILegal Description of Property (Show low or Attach Four Copies)
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U.; PERMIT
NUMBER 670258
Y..4 1 1 1 'R n - -n
13 YES )3zpo
:)NE
I LOT AREA VACA.NT SITE
I BUILDING AREA I VARIANCE I 1k
Z -4-4')� 1 — I
STREET R/W
EXISTING STREET R/W ... ....... ST. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. .......... FT.
REMARK$
CIMCKED
:9 YES [3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[3 YES XNO F_ .2.
PLAN CHECKED 117
GAS
NEW RESIDENT IAL LINE REMARHS
NON-RUSIDENTIAL El SIGN
RETAINING
El DEMOLISH WALL
ALTER EXCAVATE FENCE
1:1 OR FILL ( .......... . ........
REPAIR E3 PRE -MOVE swim
INSP. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
AM60 Krs- :t
Valuation Fee necelpt No.
vu t %j D a Uj (now&E�-5
Plan Check No ......... .. ........
PROPOSED UBE
(C re- BUILDING
Q PLOT PLAN (Indicate Building setbacks, abutting streets) PLUMBING
HEAT & GAS LINE
FENCE
t SIGN
RETAINING WALL
SWIM NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the in- TOTAL AMOUNT DUE
formation given in correct; and that I am the owner, or the duly author-
Ized agent of the owner. I ease to comply with city and state lawn regu-
lating construction; mid In doing the work authorized thereby, no person ATMNTION APPLICATION APPROVAL
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZEB This application is not a perinit until
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-
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com- knowledged in space provided.
pleS4 in mix months.)
N' TUREC,(OWN DATE SIONE INSPECTION —DIRECTORIS SIGNATURE
DEPARTMENT
OF
CITY DATEV
NOTE: Applicant &iA'ject to Plan Check Fee JUDIVIONDS 6.0,
W4O0,00
Pn 6-1107
This Permit covers work to be done on private property ONLY.
Any oonstruction on the public domain (carbs. sidewalks, driveways,
marquees, etc.) will require separate permisslon. FILE
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