680502.pdf7 BUILDING DEPARTMENT
MILI AppUcant FiH
Inside Heavy Unes
PERMIT APPLICATION
OR
NAME (OR NAME OF BUSINESS) C_
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DITI rELEPHONE NUMBER
-,4-rrL6 PtA
P NO.:
PERMIT
NU"ER 680502
RD SETBACK I STREET SETBACK HEAR
,NFE LOT AREA VACA]i
( / 0 YEs
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BUILDING AREA VARIA
4
IITE
NUMBER
STREET R/W.(,arT. DEFICIENCY THIS PROPERTY
PLAN ST. R/W.&.0 .. FT. .... 0 ... 1".
indicated on Standard Drawing #103.
Broposed Hindley Lane: CHECKI
30t from this property I VA
&ETER SIZE I SERVICE SIZE I CLEARANCE I qCCK1
C4, '--a/
?-1114 4
Legal Description of Property (show Beiow or AtLacn rour uopiesi N4
AS�0(3 7p-,Cet TYPE CONNECTION VERIFIED 'MY
&1 A PERC. TEST PERMIT NUXk��
REMARKS
'U—ss FIRE ZONE TYPE OF CONSTRUCTION STREE
re, o YES
INSPECTZM REQUIRED OCCUPANCY GROUP
j/
GAS 13 YES
RESIDENTIAL LINE PLAN CHECKEDJ�y
NON-RESIDENTIAL SIGN
D--- RETAI]NING REMAI
DEMOLISH WALL 9:
ALTER EXCAVATE PENCE
OR FILL ( ........ . x .......... Ft.)
REPAIR PRE -MOVE swim
INSP. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation Fee
Plan Check No..
7 OSED USE BUILDING
, 1'. 1. 0 6dVCCe1.,d"_1 V'AJd1?,sj-j,'P knr 1!z1d
PLOT FTAN (Indicate Nu-11dingsetbacks, abutting streets) PLUMISING ;z%
HEAT & GAS LINE
FENCE
3�
t SIGN
RETAINING WALL
71 SWIMMING POOL
DEMOLITION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
a In-
th:
I hereby acknowledge that I have read this application; that the in-
7 t'on'
r a do My an
formation given In correct; and that I am the Owner, or the duly author-
d 6
n tat law a
Ized agent of the owner. I agree to comply with city and state laws regu-
AT=NTION
thereby, no pe on
lating construction; and in doing the work Authorized thereby, no person
on
will be employed In violation of the Labor Code of the State of Washington
TIMIS PERMIT
relating to Workmens Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Your (Except DE51OLITIONS which
ONLY THE
WORK NOTED
c,
shall be completed In ninety days; MO D-XN shall be com.
pleted In six months.)
e:.*p
a TURE (OWNE OR GENT) XDE ION
INSPECTION
DEPARTMENT
CITY OF
MMONDS
NOTE: Applicant Subject to Plats Check Fee
Pit 6-1107
This permit coven work to be done on Private property ONLY.
Any construction on the pubUe domain (curbs, sidewalks, driveways,
marquees, &to.) will require separate permission.
APPLICATION APPROVAL
This application is not a pernilt until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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