690026.pdf..........
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BUILDING DEPARTMENT Applicant FM
U I L DING
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ERMIT APP ICATIQN
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MAILING ADVILEUIS
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CITY TZLEPRONN; 14UMBER
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ADDRESS
CITY
STATE LICEL413M IWAIJ3101,
Legal Description 09 Property (Sh
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ZR'OLL MAP NO.-. PERMIT 7_Qnn
NUMBER
ACK STREET 01WAWAUA,
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AC 0
I&R, YARD SETBACK
.CANT SITE
01
YES 13 NO
JUANCE NUM13ER 16
EXISTING STREET R/W SJO-FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. n/W J0 ... FT.
indicated on Standard
Eg/NEW
RESIDENTIAL
GAS
LINE
[] YES
PLAN'
ADD
ALTER
REPAIR
LEINON-RESIDENTIAL I
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
INSP.
El
D
El
SIGN
RETAINING
WALL
PENCE
. ........ Ft.
SWIM
POOL
REMAJ
I
Es
NUMBER or
DWELLING
UZ41TB
NTURE OF WORK TO BE DO*Sl,
% �
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3.
(I I -A�
Is \IJ
)NNECTION VEaBT
MST PERMIT%�TBER
TYPE OF��TRU ON STREET IMPROV]
__X, — V 1 [3 YES [3 No
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Plan Check
PROPOSED USE
BUILDING
PLOT PLA14 (Indicate Building setbacks, abutting streets) PLUMBING
HEAT & GAS LINE
PENCE
t SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
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 duty author-
ized agent of the owner. I agree to comply with city and state laws regu- ATTF24TION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington THIISPERMIT
relating to Workmen's Compensation Insurance. AUTHOR1[7XS
ONLY THE
NOTE: Permit Limit Oite Yetir (Except DE510LJTIONS which WORK NOTED
shall be Completed to ninety days; MOVEDAIN BUILDINGS shall be core-
pleted In six months.) DATE SIGN D INSPECTION
DEPARTMENT
'Por— y 6 f-
74 CITY OF
111MILONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Permit coven work to be done an Private ProPertY UNIY-
Any construction on the public domain (curbs, sidewalks, driveways,
numquees, etc.) win require sepwate permission.
Valuation Fee
dt 90, 6`19
No.
V r)
i 0613�4, 6 0 Vy g-A
APPLICATION APPROVAL
This application Is not a pem-dt until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
Imowledged in space provided. ,
FILE