680033.pdfrn
LL 31" No.: PERMIT
NUMSEIL 033
BUILDING DEPARTMENT Applicant
Inside Heavya JOB ADDRESS
PERMIT APPLICATION
U7L';'
eel
FIB! (OR NAME olf BUMNlass) 4 3_1�
—32-101
C�o .
. "3 X_
RESIDENTIAL El
GAS
LINE
NEW
16
ADD
NON-M CSIDENTIAL
SIGN
RETAINING
DEMOLISH
WALL
ALTER
EXCAVATE
OR FILL
0
PENCE
Ft.)
E]
REPAIR
PRE -MOVE
INSP.
..........
SWIM
POOL
fUMBOR OF STORIES
NUMBER OF
DWELLING
UNITS
-6
EXISTING I STREET R/W DEPICIENCY THIS PROPERTr
COMP. PLAN ST. R/W ...... .......... FT.
[3 YES 13 NO
plan Check No ......
PROPOSED UBE
BUILDING
—FL—OT PL.&N (IrOleate ISUUQ Me SetbaCKS, anutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIM313NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge Mat I have read this application; Mat the In-
formation given in correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws recu-
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 PERMT
relating to WorkmeWs Compensation Insurance.
AUTHON11M
ONLY TIM
NOTE: Permit Limit One Your (Except DEBIOLITIONS which
WORK NOTED
"I be completed in ninety days; MOVED -IN BUILDINGS shall be oom-
pleted in six months.)
111GRATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
I
CITY OF
zMaWNDS
NOTE: Applicant Subject to Plan Checle Fee
PH 6-1107
This rermit coven work to be done an private PrOPUtY ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
Marquees, 00.) will require separate permission.
E3 YES E3 NO
Fee
ca
No.
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.
WA z .
WOUL 1� III; I
P,- A MR -I WN M
N ON Of j
: I