680083.pdf-7,
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—Fo—aTED ON KROLL MAP NO.:
PERMIT
I
680
M
NUMBER
OUILUIMU UCrARI 911111
PERMIT APPLICATION I
C(-
P) D �)
Ow 06
k
L
Applicant Fill
Inside HeaVY Vnes
TOA)
-7-7
a
C) eF, ZT- )\0Q'1
NEW
F9
RESIDENTIAL
GAS
El LINE
NON-RESIDENTIAL
m SIGN
—
RETAINING
El
1:1 WALL
ALTER
DEMOLISH
EXCAVATE
F] OR FILL
FENCE
( ......... _Tkoxt.)
REPAIR
PRE -MOVE
M INSP.
swim
POOL
NUMBER OF STORIE13
NUMBER OF
DWELLING
UNITS
_RATURE OF WORK TO BE DONE
e,
y
PROP013ED U1319
PLOT P
24
*I
t
N
I
I hereby acknowledge that I have read this applIcALtlon; that the In-
formation given In correct; and that I am the owner, or the duly author.
Med agent of the owner. I agree to comply with city and state laws regu-
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE51OLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
Meted In six months.) I - —
tu-a A k (I - 13-3-8,
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways.
marquees, ate.) will require separate pz�mjvslon.
do
k A W.
REAR YARD BET13ACK
VACANT SITE
10 N
YES 3N
VARIANCE NUMBER a.
i;�S!�&G'STREET R/W DrXICIENcy THIS PROPERTY
COMP. PLAN ST. n/W ........... XT. .......... TV.
0 YES 0 NO
0 YES 0 NO
REMARKS
i5l;
No.
Plan Check No .....................
BUILDING
00
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
A'17ENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
,�.IONDS
PR 6-1101
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.
I C OR", "I'J"Al 1�
DATW (�7
f
FILE
ee�' 6 1
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