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PERMIT APPLICATION I
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f'0* SIDE YARD SETBACK I STREET BEWISAU�
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1,7- TELEPHONE 14UMBRN A7 1 13 YES El NO
ARIANCIO 14UMMMM 04
or
El RESIDENTIAL
NEW
!E
El
EN,
NoN-RESID rIALI
ION
RETAINING
WALL
DEMOLISH
ALT.
EXCAVATE
OR FILL
0
PENCE
...... Ft.)
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
UM1BER or
DWELLING
UNITS
I
ExISTING-STREur R/W
COMP. PLAN ST. R/W ....... .. rr-
[:1 YES
r] NO
Plan Check No....
P B ING
FLUN03ING
L U M
GAB LIN E
BEAT & GAS LINE
B 10 A T
PENCE
P E N CE
t
a N
SIGN
IG
N
G W A LL
R RETAINING WALL
T A
MING
S : M : POOL
W1
EMOLITION
D EM
FRIO-MOVE INSPECTION
M
EXCAVATION OR FILL
EX
TOTAL AMOUNT DUE
TOT L MOUNT Z
I hereby acknowledge that I have read this application; that the In-
formation given in 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-
ATTENTION
tsting construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
THIS PERMrr
relating to Workmen!x Compensation Imumcc-
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Your (Except DEMOLITIONS which
11
WORK NOTED
be completed in ninety days; MOVEDAN BUILDINGS shall be oom- I
shall
pleted in oil months.)
INSPECTION
SIGNATURE (OWNER OR AGENT) DATE SIGNED
DEPARTMENT
CITY OF
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done on private property ONLY.
Any Construction an tkke public domain (carbs, sidewalks, driveways,
m&Muoa@, ate.) win require separate permission.
DEFICIENCY THIS PROPERTY
13 YES 0 NO
Valuation I Fee
I I _V__ �O I (Alq!rjp
APPLICATION APPROVAL
This application Is not a permit until
eigned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Itnowledged In space provided.
1�1 - (01 -
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