670505.pdfPOSTED 4
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PERMIT APPLICATION
NAME (OR NAM OF BUSINESS)
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CITY
Applicant wtu
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NAME
ADDRESS
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CITY I �TELEPHONE NUMf3ER
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NAM
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ADDRESS
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EXISTING STREET R/W ............ FT -
COUP. PLAN ST. R/W ............ FT.
PERMIT
NUMBER 670505
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[3 YES [3 NO
DEFICIENCY THIS PROPERTY
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REMARKS
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STATE L CENSM NUMBER CITY LICENSE NUMBER
2- 7 1 — 3>47 0 I
TYPE CONNECTION
VERIFIED BY
Legal Description of Property (Show Below or Attach Four Copies)
7
PERC. TEST
PERMIT NUMBER
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REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES NO
SPECIAL INSPECTOR REQUIRED GROUP
0 YES [] NO
JOCCUPANCY
PLAN CHECKE, D BY
GAS
RESIDENTIAL
NEW
I
REMARKS
NON-RESIDENTIAL SIGN
0 RETAINING
ElDEMOLISH WALL
ALTER EXCAVATE FENCE
OR FILL ( x Ft.)
........ . ..........
PRE -MOVE swim
REPAIR INSP. POOL
F
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
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Valuation Fee Receipt No.
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Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate munuing setuarlts, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
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-
ized agent of the owner. I agree to comply with city and state laws regu.
A=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
TIUS PERMIT
This application is not a permit until
relating to Workman's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit one Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed in ninety days; MOVED -IN BUILDI.NGS shall be com.
knowledged in space provided.
plet )nth
BIG R AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
DIRECTOR'
7.
11 71
CITY OF
_,�OTE:
qDS
DATE
Applicant Subject to Plan Check Fee
This Permit covers work to be done on private Property ONLY.
PR 0-1107
Any construction on the public domain (curbs, sidewalks, driveways.
FILE
marquees, etc.) will require separate permission.
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