690278.pdfBUILDING DEPARTMENT
! PERMIT APPLICATION
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Applicant FRI
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.EPHONS NUMBER
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NAME
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24 ADDRESS
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CITY TELEPHONE 11
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- STATE LICENSE NUMBER CITY LICENSI!
12250/ 7P,6r& I
Legal Description of' Property (8how Below or Attach Four
NEW
RESIDENTIAL
I
F-1
GAS;
LINE
NON-RESIDENTIAL I
M
SIGN
ADD
0
RETAINING
WALL
DEMOLISH
EXCAVATE
PENCE
ALTER
0
OR FILL
( ........ . X .......... Ft.)
REPAIR
F-1
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
C 6
ON—KROLL MAP NO-: PERMIT
NUMBER
)DRESS
[:I YES
0
� I -11-� I I W158-
E=..�
I/W
I STREET R/W A.�e.FT.
PLAN ST. R/W .6.0 .. FT.
I (
/4% pd e-.
Plan Check No ............ . .......
BUILDING
PLUMBING
HEAT & GAS LINE
Building Setbacks, abutting streets)
%
14
C,_
Cb
11f*
tko
FENCE
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 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-
ATTU' NTION
lating 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 PERMIT
relating to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Umit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
3IGNA RE (OWN DAT19 al NED
ava" �0 �
INSPECTION
DEPARTMENT
'VO
CITY OF
MMONDS
NOTE: APPliclt Subject To Plan Check Fee
PR 6-1107
This Permit covers wark to be done on Private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
DEFICIENCY THIS PROPERTY
FT.
Z
I CHECKIZI BY
0 YEE; W-fro-
Valuation Fee
3 /3 9t7- ee r—?61
APPLICATION APPROVAL
i
I
No.
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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RECORD OF INSPECTIONS
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Datepassed.
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Foundation 7�
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Plumbing (Partial)
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