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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLI( Inside Heavy Lines
NAM (ORNAMEOFIJUu EBB)
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1,L MAP NO.*.
PERMIT
NUMBER
UBE ZUIVO
OYES 240
ARLALNCE NUMBER
EIGHT —il jB6N9GL 0/ _JV L 0
1 1/ 3? 4/ 7 0 1 —
1:RESIDENTIAL
1
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F-1
GAS
LINE
NEW
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LNON-PXSMENTIAL
SIGN
0
RETAINING
�""
DEMOLISH
F1
WALL
ALTER EXCAVATE
OR FILL
PENCE
( ........ x . ........ Ft.)
REPAIR PRE -MOVE
INSP.
swim
POOL
iUMBER OF STORIES NUMBER OF
DWELLING
UNITS
fATURE OF WORK TO BE DONE
/� --.% � &0,a , -77- -
K .016
�;REET R/W ........... PT. DEFICIENCY THIS PROPERTY
LAN ST. R/W ........... ST. ........... PT .
[] YE13 Q NO
Plan Check No....
BUILDING
PLUMBING
BEAT & GAS LINE
PENCE
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-
ATTENTION
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 Inmuranoe.
AUTHORIZES
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORH NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS &bull be com-
pleted In mix months.)
SIGNATURE (OWNER OR AGENT) ATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
E"BIONDS
NOTE: Applicant Subject to Plan Check Fee
PR SAM
This Permit covers Work to be dons On Private property ONLY.
Any construction on the public domain (curb@. sidewalks, driv&wayso
marque", etc.) will require separate permission.
[] YES 13 NO
Fee I Receipt No.
M31111KII-In
1 �1-7. & b V,5 10 �
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-
Itnowledged in space provided.
FILE
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