680258.pdfI;O—S—TEDON XROLL MAP NO� PEMUT 8025U
NUM13ER
BUILDING DEPARTMENT Applicant Fill
rpEIRMIT APPLICATION 'wide Heavy L"nesi—i-oB —"IDRE13E, <7 17 t .I
J
a
0-I&W
RESIDENTU
R
LS
_1A
I -I NE
`SIGN
NON-RESIDI TIAL
MADD
El
RETAINING
WALT,
DDEMOLISH
ALTER
0
EXCAVATE
OR FILL
El
PENCE
( .......... x .......... Ft.)
El REPAIR
El
PRE -MOVE
INSP.
El
SWIM
POOL
IUMBER OF STORIES
I —NUMBER OF
DWELLING
UNITS
TO BE DONE
SIDE 'YARD
STREET YETBACK REAAt
�SETBACK
TE
13 NO
NUMBER Ak
EXISTING STREET R/W :5.0 .. FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/w FT.
indicated on Standard Drawing #103.
13 YES
tt
le
I
13 YE13 [3 NO
I
JXV
Valuation Fee Receipt No.
Plan Check No ............ .......
PROPOSED utjlqj
BUILDING
PLOT P �AN (Indicate BuIldl T�51 abutting ntreetsT_ i
PLUMBING
BEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
01
SWIMMING POOL
DEMOLITION
VS 3 Vt
PRE -MOVE INSPECTION
f
411
EXCAVATION OR FILL
TOTAL AMOUNT DUE
49'. v 0
I hereby acknowledge that IThave read this application; that the in-
formation given Is correct; and that I am the owner, or the duly author -
,zed agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and in doing the work authorized thereby, no Person
will be employed In Violation Of the Labor Code of tile State of Washington
THIS PERMIT
This application Is not a permit until
relating to-WorkMen'S Compensation Insurance.
AUTHORIZES
Signed by the Building official or Me Dep-
NOTE: Permit Limit one Year (Except DE51OLITIONS which
ONLY THE
WORK NOTED
utY; and fees are paid, and receipt is ac-
shoal be completed in ninety days; BIOVED-IN BUILDINGS shall be com-
knowledged in space provided.
plated in mix months.)
-L DATE FI—GNED
3IGNATURE (OWNER OR A GENT)
INSPECTION
1) T .,SI U
01
DEPARTMENT
r e
(e J
CITY OF
P FONDS
DATE
NOTE: Applicant Subject to Plan Chech. Fee
rn il-iifI7
This Permit covers worK VO be done on private property ONLY.
Any censtractlon on the publ!c domain (curbs, sidewalks, driveways.
marquees, ate.) will requirS separate permission-
Flux
9