670510.pdf:4
BUILDING DEPARTMENT Applicant F111
PERMIT APPLICATION Inside Heavy Lines
NO.:
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TELEPHONE NUMBER
�7 Y3 - �ld 6, 'V
EXISTING BTRELT R/W ............ PT
COMP. PLAN ST. R/W ............ IT
a 0?_ d ?;, I
c2:2- 3 — e a - /.-" 0 3
0 YES
FIRESIDENTIA GAS E
EJNEW LIN
1 11 NON-REBIDP�LJ,IAL SIGN
0 RETAINING
F] DEMOLISH WALL
ElALTER EXCAVATE PENCE
0 OR FILL ( .......... x .......... Ft.)
El REPAIR PRE -MOVE SWIM
n INSP. POOL
;UMBER OF STORIES NUM33ER OF
DWELLING
UNITS
4ATURE OF WORK TO BE DONE .
TYPE
[] NO
Plan Check No .....................
PROPOSED UBE
BUILDING
PLUM33ING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
PENCE
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 Is correct; and that I am the owner. or the duly author-
ized agent of the owner. I &glee 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 PERIMIT
relating to Workmen's Compensation Insurance.
AUTIIORIZES
NOTE: Permit Limit One Year (Except I'll-nJOLITION'S which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
lIGNATURE (OWNER OR AGENT)
E
DATE ION D
INSPECTION
alA,
DEPARTMENT
CITY OF
ELPMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6.1101
This Permit covers work to be done on private property ONLY.
Any construction on tile public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
PERMIT
NUMBER 670510
I
YES [] NO
DEFICIENCY THIS PROPERTY
....... .... 1".
[:] YES [] P40
Valuation I Fee
z
RM
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or bis Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DI C 0 S BIG T RE
DATE
RF