690048.pdf0
BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
inside Heavy Lines
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iG ADDRESS
TELEPHONE NUM
D/W,67 A/ 11, 3 - dl 6
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TT-ATELICENSE NUMBER CITY LICENSE NUMBER
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Legal Description of Property (Snow BeLOW or Attach Four Copies)
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RESIDENTIAL
GAS
LINE
NEW
I
NON-RESIDENT1,011,
F�
SIGN
ADD
"
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
OR FILL
PENCE
( ........ . x .......... Ft.)
REPAIR
1:1
PRE -MOVE
INSP.
swim
POOL
ES
NUMBER OF
DWELLING
0?I
UNITS
-WATURE _0F WORK TO BE DONE
ON XROLL AULP NO-: PERMIT
I00Z, � ) I NUMBER
)RESS
q
�RD
SETBACK
STREET SETBACK
REAR TA
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M J'�
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4q !S- I
INE
LOT AREA
VACANTI
't
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(3 YES
EXISTING STREET R/W ............ FT -
COUP. PLAN ST. R/W ........... XT-
[] YES
I-r,rg4:)4 &40no,6 -roHo1A9;K Plan Check No ............ . .......
ROPOSED USE
BUILDING
PLUMBING 7
HEAT & GAS LI�E
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 to correct; and that I am the owner, or the duly author-
a
ized agent of the owner. I agree to comply with city and state laws regu-
a
lating construction; and in doing the work authorized thereby, no person
'z 'In
I g
ATMNTION
will be employed in violation of the Labor Code of the State of Washington
11 bc
relating to Workmen-s Compensation Insurance.
Un
LNOTE: Permit Limit One Year (Except DEMOLITIONS which
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be core-
W I
plated in six months.)
INSPECTION
ONA UBE: 7(Q=_1 TE SIGN�D
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DEPARTMENT
CITY OF
M"IT&UNDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
his Permit covers work to be dam on private property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways,
marquees, etc.) will require separate Permission.
DEFICIENCY THIS PROPERTY
........... ITT.
BY
� — I
ICTION
— AJ
Valuation
13 YES 13 NO
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—101
3 6,
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-
Imowledged in space provided.
DIRECTOR'S 13IGN
6