680040.pdfPO
BUILDING DEPARTMENT
Applicant Fill
PERMIT APPLICATION
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NAME (OR NAMIG OF BUSINESS)
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MAILING ADDRESS
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CITY
TELEPHONE NUMBER
PP. 19
NAME
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TELEPHONE NUMBER
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CITY
Tz"PHONE NUMBER
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STATE LICENSE NUMBER
CITY LICENSE
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Legal Description of Property (Show Below or Attach Four Copies)
E
GAS
NEW RESIDENTIAL LINE
NON-RESIDENTIAL BIGN
ADD RETAINING
DEMOLISH WALL
ALTER EXCAVATE FENCE
El OR FILL ( x Ft.
.......... .........
REPAIR 1 PRE -MOVE SWIM
El INSP. POOL
NUMBrOF STORIES
/ N &.4j)
NUMBER or
DWELLING
2!a:�Yjsr7wr,
UNITS 5, Pe 40
NATURE OF WORK TO 13E DONS
PROPOSED USE
0 44
PLOT PLAff (Indleate Building setbacks, abutting streets)
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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.
lating conxtrucUon; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
rat ng to o kineal p nsatton Insurance.
N E: e t Mmi ne Year (Except DEMOLITIONS which
11 omp t d in Din y days; jjjOVED-3[N BUILDINGS shall be oom.
I te six o the.) /117
BIG r (O"EP/OR AG9AT/
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NOTE: Applicant Subject to Pla;(Chcck Fee
This Perrult covers work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driverways,
marquees, etc.) win require separate permission.
DN IMOLL MAP NO.* PERMIT
/ NUMBER 680040
VA—C&NTSITE
[3 YE13 13 NO
VARIA;CM NUMBER
CISTING - STREET R/W .... ...... XT. DEMCIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... XT. ........... 1".
] YES 0 NO
'Lan Check No
lUrLDING
-LUIMNG
1EAT & GAS LINE
FENCE
3IGN
RETAINING WALL
SWIMIUNG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
MMONDS
PH 6-1107
[:] YES [3 NO
Valuation
901
1 /01001
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.
DIREC OR'S BIG RE
DATE
'7
FILE
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/ A