690128.pdfi
UUILUINU utrAximtroi ApplicantFill
PERMIT APPLICATION Inside Heavy lAnes
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NEW
RESIDENTL4L
GAS
LINE
NON-RESIDENTIAL
SIGN
RETAINING
DEMOLISH
WALL
El
EXCAVATE
FENCE
ALTER
OR rJyj
El
(
REPAIR
PRE -MOVE
INSP.
M
... . ... .
SWIM
POOL
DWELLING
UNITS
I hereby acimmledge that I have read this application; that the In-
formation given In correct; and that I am the owner. or the duly authar-
lzed agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authortted thereby, no person
will be employed in violation of the Labor Code of the State of Washington
relaung to WorkmeWs Compensation Insurance.
NOTE: Permit Umit One Year (Except DEMOLITIONS which
shall be completed in ninety days, MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applieant Subitt-1 to Plan Cheek Fee
This Pernalt covers work to be dam Oct private Property ONLY.
Amy construction on the public domain (curbs# sidewalks, drivewaysp
marquesso oft.) wtH require separate permlaslon.
POSTED N KROLL it" NO.:
PERMIT
NUMBER 690128
JOA ADDRESS
&/ W M
14/
BID SE7rBACl
Y
STREET SETBACK
REAR VAR D BET13ACK
1
1
110 1
-� .5- (M
.51
IQ �m
USMM
I�Vr AREA
VACANT SITE
13 YES 0
kN
HEIGHT
BUILDING AREA
VARIANCE UMBER
04
PLOT PLAN APPROVED
STREET RjW
EXISTING STREET R/W -- — --- VT.
COMP. PLAN ST. R/W ....... IT.
[:] YES
Plan Check No...
BUILDING
PLUMBING
BEAT & GAS LaM
PENCE
13IGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTEr-MON
THIS PERMIT
AUTHORIZZ15
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
OITY OF
MMONDS
PIL 6-1107
DEFICIENCY THIS PnoPznTY
'9Q, &V
-6
�GKED BY
J
CHECKED BY
3Y
STREET IMPROVED
13 YES
cup
Fee
Receipt No.
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APPLICATION APPROVAL -
This application is not a permit 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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