670418.pdfJiM
BUILDING DEPARTMENT
PERMIT APPLICATION
N"IQ (OR NAME or BUSINESS)
A. L, oweA I.
MAIIANG ADDIU;1111
7
86
CITY
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NAME
CITY
8
or
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Applicant Fill
inside Heavy Lines
W.
PHONE Nub-
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U
NEW
RESIDENTIAL
I
El
GAS
LINE
IR
NON-RESIDENTIAL
D
SIGN
F-1 AUV
El
RETAINING
WALL
DDEMOLISH
El ALTER
D
EXCAVATE
OR FILL
El
PENCE
( .......... x .......... Ft.)
E] REPAIR
PRE -MOVE
INSP.
swim
POOL
,�ZUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
PERMIT
NUMBER
A"UILZOD -
I rl 0 r) - I�T
!�,_1113 SETBACK STREI-.'T tJNL"AUK EAR YARD SETBACk
YES 13 NO
-.--A ../ .. Y THIS PROPERTY
EXISTING STREET R/W ............ FT- DEFICIENC
COUP. PLAN ST. R/W .......... — ............ F.T.
[3 YES
[] NO
Plan Check No ..... ..............
BUILDING
(Ina]CatO JJU11G1ng Beto=", abutting streets)
PLOT PIA.N PLUMBING
03
HEAT & GAS LINE
FENCE
t SIGN
N
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-
Ize,d agent of the owner. I agree to comply with city and state laws 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
relaung to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Umit One Year (Except DE31OLITIONS which NVORK NOTED
shall be completed in ninety dayn: MOVED -IN BUILDINGS shall be com-
pleted In nix months.) _SIGI INSPECTION
.-§�IGNATUIM (OV VNER OR AGENT) —7-1 DATE IED DEPARTMENT
� �?, Z - �?-/- .1,7 CITY OF
9 �=01111 EDNIONIDS
NOTE: Applicant Subject to Play; Check Fee PR 6-1107
This remit covers work to be done an privnte property ONLY.
Any construction on tho public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
z
IQ
I
C] YES [] NO
Valuation I Fee I Receipt No.
= M04 IIIIIN
5-f 0 4� 73cr 1
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.
'. .17 1* _�
rl- / - �, 7
FILE
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