670471.pdfBUILDING DEPARTMENT
Applicant Fill
PERMIT APPLICATION
CS
Inside Irleavy Lines
NAM (OR NAM OF BUSINNUM)
MAILING ADDRESS
z
/142-
CITY
TE PHONE NUMBLA
TELEPHONE NU.B._j
PR -7,50
NAME
ADDRESS
CITY
TELEPHONE NUMBER.
NAMID
CA S <�_ S 7-/?�
ADDRESS
712-c, C,,QzI, 44�-
CITY
LEPHONE NUMBE&L
11-4
S' - 7 4447-
STATE LICENSE NUMBER
CITY LICENSE NUMBER
2_�2_ �> (=) 1 5-(0.4- 1
Legal Description or 1-roperty (unow Lseiow or Attach Four Copies)
GAS
RESIDENTIAL M LINE
E] NEW
AL
NON-RESIDENTI r 1 SIGN
10 A�u
DDEMOLISH
RETAINING
D WALL
DALTER EXCAVATE
D OR FULL
PENCE
( .......... x .......... Ft.)
REPAIR PRE -MOVE
FI INSP.
swim
POOL
NUMBER Or STORIES NUMBER OF
DWELLING
UNITS
/0 9"'-
ADDRESS
E YARD BET13AC
I I
EXISTING STREET R/W ............ FT -
COMP. PLAN ST. R/W ........... Fr.
TYPE OF
Ij YES [] NO
PERMIT
NUMBER 670471
-2./ e wtn 15-7- '5 e-A
[] YES [3 NO
DEFIGIENCY THIS PROPERTY
[3 YES [3 No
ow
A 12 A 6. E
Valuation Fee -Receipt No.
Plan Check No ............ ... ....
PROPOSED USE
BUILDING
PLOT PLAN (Indic ullding setbacks, abutting streets)
PLUMBING
P/Fje- '577
HEAT & GAB LINE
FENCE
t
SIGN
0-
RETAINING WALL
7 04 (4
Lo N
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 arn the owner, or the duly allthor-
Ized agent of the owner. I agree to comply with city and state laws rsgu-
AT=NTION
APPLICATION APPROVAL
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
This application is not a permit until
relating to Workmen-0 Compensation Insurance.
AUTHORIZES
signed by the Building official or Ws Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORH 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.
pleted In six months.) ED
3IGNATURE (OWNNIt U1VVLUZ"L) DATE SIGN
INSPECTION
DIVT R 81UN
lAec_
A
DEPARTMENT
-1
77
oil / (L)A_ 7
CITY OF
-
Fec
EDBIONDS
DATE
NOTE: licant sitYiect to Plan Check
PH 6-1107
This Permit covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways.
FILE
marquees, etc.) will require separate 11cmilslun-
P