680086.pdfBUILDING DEPARTMENT Appucant m
Inside Heavy Lines
PERMIT APPLICATION
NAME (OR NAME OF BUBIN
+ 4m.
RES
6 o(76 A
9
7r—Attaeh
0
rJ&
NEW RESIDENTIAL ASE
NON-RESIDENTIAL R sIGN
M RETAn-nNG
DEMOLISH WALL
ALTER EXCAVATE FENCE
OR FILL ( .......... x . ........ Ft.)
E] REPAIR PRE -MOVE SWIM
El INSPI NU El POOL
MBER or
DWELLING
UNITS
OD ON RKO—" MAP NO.:
PERMIT
NUMBER
b0UU00
DURESS
YARD SETBACK
07 0*
J."�
13TREET SETBACK
REAR YARD SETBACK
Z2NE
LM AREA
A SITE
E3 TEO [3 NO
I VARIANCE NUMBER
EXISTING STREET R/W
COMP. PLAN ST. R/W
R
E] YES
C3 NO
Plan Check No ..................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate BUIldiTi4etbacka, abutting streets)
PLUMBING
=AT & GAS LINE
FENCE
t
SIGN
0.1
70
RETAINING WALL
SWIMMING POOL
a 3
DEMOLITION
PRE -MOVE INSPECTION
3G
EXCAVATION 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 rGgu-
ATTENTION
I&ting 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 Workmen-0 Compensation Insurance-
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Your (Except DEMOLITIONS which
WORK NOTED
shoal be completed in ninety days; MOVED-ILN BUILDINGS shall be 00m'
pleted in six months.)
i DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
11107nDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This permit be done on pxjvMe propertY ONLY.
ware work to
Amy oonstruclion on the public domain (curM, sidewalks, drlvew&Yo,
marquess, so.) Will require separate Parlolss[Offlk-
DEFICIENCY THIS PROPERTY
i 'o-or �
(3 YES 13 NO
Valuation I Fee
a -.000
1 3 " 6 06
I
11
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees exe paid, and receipt is ac-
knowledged in space providell. 'd
=WAAW
'e e-
I I I