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BUILDINS) DEPARTMENT Apploanj Fin
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PERMIT APPLICATION I --I � -
P NO.: PE41MIT
I NUMBER 690038
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MAUZ G ;X610E-88 USE ZONE L . OT AREA
��� IF/— ;�L� E] YES NO
CITY TELEPHONE PIUAIJJ� HEIGHT AREA VARIANCID U E
NAME to
PLOT PLAN APPROVED
as
ET R/W
rm-LIEPHONE NUMBER EXISTING STREET n/W ............ FT- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT- ..........
REMARKS
cHzCKED BY
Ile
�71
METER SIZE SERVICE SIZE CLEARANCE CHEOMM BY
Tjr'LEPHoN NUMBER 04
Legai Description o property (allow miow or Ailaca ruux
R 0. T _ES T PERMIT NUMBER
C] YES 13 NO
RESIDENTIAL
-1
F
GAS
LINE
DNEW
ElNON-RESIDENTIAL
j
SIGN
�V
0
RETAINING
WALL
DDEMOLISH
ALTER
0
EXCAVATE
OR FILL
El
FENCE
( .......... x . ........ Ft.)
El REPAIR
Q
PRE -MOVE
INSP.
SWIM
POOL
mUMBER OF BT01UNU
NUMBER OF
DWELLING
UNITS
[3 YES [3 NO
Fee Receipt No.
&V ok r
Plan Check No ............ . .......
-FR—OPOSED USE
BUILDING
—ding 11 i]Ting
FiFf JPE�[j�j �16; EFate Bull setbaclui, streets)
PLUMBING
ev-4-
0
HEAT & GAS LINE
FENCE
t
SIGN
RETAINING WALL
SWIM NG 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 duly author-
Ized agent of the owner. I agree to comply with city and state laws regu-
AT=NTICON
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
be employed in violation of the Labor Code of the State Of Washington
THIS PERMIT
This application is not a permit until
will
relating to Workmen'IS Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITION'S which
ONLY THE
WORK NOTIED
uty; and fees are paid, and receipt is ac-
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
pleted In six months.)
SIGNATU RE OWNER OYRAGNT) DATE 8 G ED
INSPECTION
D a RE
DEPARTMENT
ILL
CITY OF
Check Fee
I ED31ONDS
DATE
NOTE: Applicant Subject to Plan
C�
PH 6-1107
This permit covers work to be done onprivate property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.
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