680003.pdfUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
or
Applicant Fill
Inside Heavy Lines
0
RESIDENTLALL
GAS
LIND
NEW
ElNON-RESIDENTIAL
SIGN
F1
RETAINING
WALL
EJDEMOLISH
ALTER
n
IDCCAVATE
PENCE
OR FILL
( ........ . x . ........ Ft.)
REPAIR
PRE -MOVE
INSP.
swim
POOL
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
I
PERMIT
NUMBER 680003
1 :J-17) --A �
7
0 r —
REAR TARO SETBACK
VACANT SITE
[3 YES [3 NO
VARIANCE NUMBER
EXISTING'STREET R/W DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT- . ........... IT. —
[] YES [3 NO
Plan Check
V6�OSMD USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
XeZ _51$eev
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
MCCAVATION 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 agree to comply with city and state laws regu-
ATTEhMON
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
relating to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six montho.)
IIGNATURE (OWN R AGENT)
DATE SIGNED
INSPECTION
b
DEPARTMENT
CITY OF
MMO
NOTE: Applicant Subject to Plan Check Fee
PR 6.1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (Carbs, sidewalks, driveways,
marquees, etc.) %vill require separate permission.
Valuation
0 YES 0 NO
Fee
I r1a 5-0 14 ( q �
APPLICATION APPROVAL
This application IS not it permit until
signed by the Building Official or b1s Dep-
uty; and fees are paid, and receipt Is ac-
lmowledged in Space providedL
"I �_7 11
— 619�
FILE
9
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