680273.pdf. ... ... .. .. ...
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1_81�11LDING DEPARTMENT Applicant F111
PERMIT APPLICATION InsIde Heavy Unes
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PERMIT
NUMBER
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STBACK
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RMAR YARD BEF
VACANT 81TE
13 YES )6
Pei I P7
P7 STREar/W DEFICIENCY THIS PROPERTY
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10 NON-RESIDEN TIAL
SIGN
ErADD
RETAINING
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MDEMOLISH
laALTER
EXCAVATE
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REPAIR
FRIO-MOVE
rNSP.
SWIM
POOL
NUMBER OF
DWELLING
UNITS
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NO
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Valuation Fee Receipt No.
CPA— Agle�
Plan Check No ................ ..
PROPOSED USE
/a -
BUILDING
PLOT PLAN Aludicate Isnuutog setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FMNCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
0
I hereby �knowledffs that I have read this application; that the in-
formation given to correct; and that I am the owner, or the duly author-
ized agent of the OVIer. I agree to comply with city and state laws regu-
ATTENUON
APPLICATION APPROVAL
lating construction; 'apd in doing the work authorized thereby. no person
will be employed in violation of the Labor Code Of the State Of Washington
THIS PERMIT
This application is not a permit until
relating to WorkmeWN Compensation insurancie.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit one Your (Except DE51OLILTIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
mhall be completed In ninety days; MOVED-ICN BUILDINGS shall be com-
Imowledged in space provided.
pleted In nix months.)
SIGNATURE (OWNER OR AGENT) I DATE 13IGNED
ge
INSPECTION
DEPARTMENT
A012-M-A
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'eeay'e"W-ef
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CITY
EIDMONM
NOTE: APPlicant Subject to Plan Check Fee
PR 6-1107
This permit covers work to be done an Private property ONLY -
Any construction on the public domain (curbs, sideW&W, drivOWAYN,
marquees, etc.) will require separate PeAv"8101m-
FILE
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