670281.pdfL
BUILDING DEPARTMEN
PERMIT APPLICATION
I NA4Jq (OR NAMJJ6OF_BUWEBS) _
POSTED ON KROLL MAP 14u-: PERMIT
Applicant FM I NUMBER
131181416 Heavy LinCS JOB ADDRESS
ri
I—OMNG ADDRESS
//,-X -7 , I
0 "a El No
EXISTING STREET R/W ........... IrT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ PT.
70
TELEPHONE NUMBER
/-*- -;�6f'r
CiTr LICENSE NUMBER
T1
seiow or Attach Four Copies)
A
NEW
RESIDENTLA
0
GAS
LINE
NON -RESIDE TIAL
SIGN
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
OR FILL
PENCE
( x Ft.)
.......... ..........
REPAIR
13
PRE -MOVE
INSP.
SWIM
POOL
NUMBER or
DWELLING
UNITS
1%
[3 YES
13 NO
Plan Check No ... . ........... ...
BUILDING
PLUMBING
t
N
HEAT & GAS LINE
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 to correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws regu.
ATTENTION
lating constzuction; 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
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTZD
shall be Completed in ninety days; MOVED -IN BUILDINGS ahaAl be com-
pleted In all months.)
INSPECTION
DEPARTMENT
1
�DAT4 SIGNED
S�7_04y 19 7
RL CITY OF
IDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This rermit covers work to be done on private Property ONJ6x.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate Permission.
Valuation
YES
Fee
.60
NO
I 10.0013.yq
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.
DATE
FILE
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