690199.pdfPERMIT APPLICATION
NAMIG (OR NAME OF BUSINESS)
B N191Zd A". PIChy,
MAILING ADDRESS
/00y 11�N NI/5.
CITY
WR,5H—.LT;
.8o,Lr sy owiyak*
or
a el I
lu-11
IA/ 1,6 0
.1
Inside Heavy Lines
-,� - �Y/ 9,9
I
RESIDENTIAL
GAS
LINE
ElNEW
NON-RESIDENTIAL
SIGN
K�w
RETAINING
WALL
ALTER
El
DEMOLTAF
EXCAVATE
OR FILL
FENCE
( x rL)
........ . ..........
REPAIR
1:1
PRE -MOVE
INSP.
swim
POOL
FE-81
NUMBER OF
DWELLING
UNITS �
PERMIT
NUMBER
d.17 -
0
LOT AREA VACANT SITE
E3 YES
r nlp-n A .1
EXISTING I STREET R/W .... ...... XT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R1W .. . ...... I"- .......... FT.
[]. YES
[3 YES [:] NO
No occupancy until house is connected
to sewers. 5-26-69
Plan Check No ............. .......
BUILDING
Q
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
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 to 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-
lating construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Slats of Washington
AT=NTioN
THIS PERMIT
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
AUTHORIZES
ONLY TBE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in at% months.)
-§I-GNATURE (OWNER OR AGENT) SIGNED
INSPECTION
DEPARTMENT
My OF
MITIONDS
NOTE: Applicant SubjecIt"to Plan Check Fee
PR 6-1107
This Peffult coven work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalkes drivewaymp
rnarquees, etc.) Will require separate permission.
Valuation
APPLICATION APPROVAL
No.
V,
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.
-C;4-[0 -(C.? i
FILE
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