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BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR v 88)
AbIN UN
Applicant Fill
Inside Heavy Lines
MAILING ADDREM
,a- _Q1_Ty WEEE_FHONE NUMBEII
NAME
DREISS
CITY I TSIXPHONE NUMBER
CITY
—WTA—T
L W
;r. —
or
G S
NEW
Tr
RESIDENTIAL
LINE
El
RES
No N- ; IDENTIAL
SIGN
ADD
RETAINING
WALL
DEMOLISH
ElALTER
EXCAVATE
OR FILL
FENCE
( ........ . x ..........
E] REPAIR
PRE -MOVE
INSP.
SWIM
POOL
qUMBER OF STORIES
I NUM13ER OF
DWELLING
UNITS
IOLL MAP NO.: PERMIT
I NUMBER 690408
YES El NO
EXISTING STREET R1W ........... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT. 0
`ff EMARX S
L
—METER SIZE, SERVICE SIZE CLEARANCE CHECKED BY
Cd
REMARKS
TYPE CONNECTION VERIFIE BY
PERC. TEST PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
1 0 YES [3 xc
(3 YES 0 NO
PLAN CHECKED By
REMARKS
rian Check No ...........
Valuation I Fee
No.
BUILDING
—PROPOSED USE
PLUMBING
LINE
PLOT PLAN (i—nd—Icato Building setbacks, abutting streets)
HEAT & GAS
FENCE
SIGN
t
RETAINING WALL
N
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 Is correct; and that I son the owner, or the duly author -
and state laws regu-
APPLICAT ION APPROVAL
lzed agent of the owmer. I agree to comply with city
ATTENTION
latIng construction; and In doing the work authorized thereby, no Person
In violation of the Labor Code of the State of Wazblngton
TIUS PEltl%IIT
This application is not a permit until
will be employed
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or I -As Dep-
ONLY THE
uty; and fees are paid, and receipt Is ac-
NOTE: Permit Limit one Year (Except DE151OLITIONS which
WORK NOTED
lmowledged in space provided.
shall be completed in ninety days; MOVED -IN 13UILDINGS shall be com-
pleted In mix months.)
SIGNATURE (OWNER 911 AGENT) DATES NED INSPECTION
DEPARTMENT
DLRECTOR'S SIGNAT
/0 /-bO
0 F
CITY
EDIVIONDS
DAT
NOTE: Aj)plicant Subjcct to Plait Check. Fce
PR 0.1101
This Ilermit coven work to be done on private property ONLY.
11,
Any construction on the public domain (carbs, sidewalks, driventpja,
FILE
marqueesp etc,) will require sep�te permission.
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