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BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
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FfELEPHONE NUM13MR
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NAME
CITY TELEPHONE NUMBER
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CITY TELEPHONE NUM33ER
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HTAWM LWEINISE NUA2� LICENSE NU MBER
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Legal Description of I - or Attach Four Copies)
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ElRESIDENTIAL GAS E
LIN'
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�TIAL
El NON-RESIDENITIAL F_� SIGN
RETAINING
EkIDEMOILISH WALL
ALTER EXCAVATE PENCE
M OR FILL ( .......... x .......... Ft.)
REPAIR r-1 PRE swim
INS�MOVE POOL
DWELLING
UNITS
0
C] YES
YARD SETBACK
4T SITE
13 NO
.NCM NUMBER
EXISTING STREET R/W ............ PT- DEPICQIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ rr. ..........
RE�S
13 YES E3 NO
Plan Check No .....................
P n k N 0
is C ecG
B I I
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BUILDING
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PLI13EELING
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HEAT & GAS LINE
H E A T
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PENCE
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13
SIGN
N
N G A LL
RETAINING WALL
R E A I W
S WIMMI G POOL
WIMMING POOL
DEMOLITION
EM
-MO N CTION
PRE -MOVE INSPECTION
P F I Sp
T FILL
EXC to 0
EXCAVATION OR FILL
M
, OUNT
TOTAL AMOUNT DUE
TOTAL
13 YES 13 NO
Valuation I Fee
No.
I hereby acknowledge that I have read this application; that the In-
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formation given is correct; and that I am the owner, or the duty author-
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Izod agent of the owner. I agree to comply with city and state laws regu-
agen
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ATIENTION
APPLICATION APPROVAL
I&Ung construction; and in doing the work authorized thereby, no person
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be employed in violation of the Labor Code of the State of Washington
11 be am PI
THIS PERMIT
This application is not a perrait until
will
relating to Workman'll Compensation Insurance.
ung to
AUTHORIZES
signed by the Building Official or his Dep
NOLTE: Permit Limit one Your (Except DEMOLITIONS which
ONLY IME
WORK NOTED
uty; and fees are paid, and receipt Is ac-
shall be completed in ninety days; MOVED -IN BUILDINGS shall be eom.
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knowledged in space provided.
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plated in six months.)
MECTOR'S SIGNATURE
Tu DATE SIGNED INSPECTION
NA RE (OWNER OR A
DEPARTMENT
to
CITY OF
FDATE,''
NOTE: Applicant Subject to Plan Check Fee
17
PR 6.1107
This permit covers work to be done on Private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.
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