670545.pdfI
I IV BUILDING DEPARTMENT Applicant Fill
- 4A I DEDMIT Annil Irmide H Lines
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OF BUSINESS)
MA LING ADDRESS
3 4( q�k
CITY TEI_,YFHL)N0 NU BER
I'M bLM
7GP:
or
GAS
ErRESIDENTI.L LINE
NEW
[D�ADD NoN.r-tESIDENTLkL SIGN
RETAINING
0 WALL
DEMOLISH
ALTER EXCAVATE PENCE
M OR FILL ( Ft.)
1
.......... x ..........
PRE -MOVE SWIM
E]
REPAIR
INSP. POOL
NUMBER OF
DIVELLING
0
UNITS
NATURE OF WORK T BE DONE
Ad to a / � 77, 61 � L10 4�r, L wwo
PERMIT
NUMBER 670545
JOB
X19
EDZ rAnv o�Lm,L�� I zAAV bETJJA:
0 YES 0 NO
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FrT. .......... I" -
REMARKS
ZONE
[] YES [3 NO
,#7VL4q-r,
Plan Check No ..... ...............
PROPOSED USE
BUILDING
PLOT PLAN 1.112910110 Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
L—,..- A
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby ackuawladge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly au—m-
Ized agent of the owner. I agree to comply with city and ste.e laws roru-
latIng construction; and In doing the work authorized thereby, no person
ATTENTION
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 Year (Except DEMOLITION's which
ONLY TILE
WORK NOTED
shall be completed In ninety days: BIOVED-IN BUILDINGS shall be com-
pleted In sIxJP"s.)
1IGNATU =(O 0 AGENT)
DATE SIGNED
P
INSPECTION
DEPARTMENT
CITY OF
IDDIVIONDS
NOTE: Applicant Subject to Plan Check Fce
PH 0-1107
This Permit coven work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
[3 YES [3 NO
Fee
S7,n 0- 10
No.
I 1 91-00 Ulln
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.
5
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