680284.pdfPERMIT APPLICATIO14 Inside Heavy Lines
NAME (OR NAM OF BUUINEBS)
'Eo 1111-L'IF-P,
-VARILING ADDRESS
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CITY TELEPHONE 14UMBE-R
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SIDE YARD SETBACK I
—7
STREET SETBACK
HEAR YAHLY 1521'V�AVK
NEW
RESIDENTIAL
I
F1
GAS
LINE
El
NON-RESIDENTLAL
El
FZ71
ADD
SIGN
RETAINING
0
DEMOLISH
El
WALL
DALTER
EXCAVATE
FENCE
n
OR FILL
( x Ft.)
REPAIR
M
PRE -MOVE
INSP.
.......... .........
SWIM
POOL
DWELLING
UNITS
NE
I* 41V
CISTING STREET R/W ............ FT.
COUP. PLAN ST. R/W ........... IPT.
[] YES
0 YES
DEFICIENCY THIS PROPERTY
............ 147.
0 YES [3 NO
Z
L
Plan Check No ........ ... ........
PROPOSED USE
200 KI-1 SW
BUILDING
2- 4:9 0 .9 "7 —0n
PLOT PLAN (Indicate ButldlDgt�eetbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
Sol—
SIGN
I <_ ir TA L
RETAINING WALL
SWIMMING POOL
DEMOLITION
L;
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In-
TOTAL AMOUNT DUE
formation given to correct; and that I am the Owner, or the duty author-
Ized agent of the owner. I agree to comply with city and state lawn rogu-
ATTENTION
APPLICATION APPROVAL
latlog construction; and in doing the work authorized tboreby, 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 WorkmeWs Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Umit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED-31N BUILDINGS shall be rom.
Imowledged in space provided.
pleted in six months.) ,
FIG-N).STURP, (OWNER OR AGENT) DATE SIGNED
INSPECTION
DIR.ECTOR'S §WNATUIW
DEPARTMENT
CITY OF
MMONDS
DA
"T'
NOTE: Applicant Subject to Plan Check Fee
PH 0-1107
This Permit covers work to be done an private property ONLY.
Any construction an the public domain (curbs, sidewalks, drlv&wvvm,
marquees, etc.) will require separate permission.