690445.pdfBUILDING DEPARTMEN'
PERMIT APPLICATIONTA
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Applicant F111
Inside Heavy Lines
CITY ELEPHONE NU
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RESIDENTIA I. I
R
LINE
NEW
NON-RESIDENTIAL
SIGN
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
OR FILL
FENCE
( ........ . x ......... Ft.)
REPAIR
PRE -MOVE
INSP.
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POOL
DWELLING
UNITS
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PERMIT
NUM13ER
,?00,f /e0OCi7l
EXISTING STREET R/W .......... FT -
COUP. PLAN ST. R/W ............ FT.
0 YES El NO
plan Check No....
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEWOLITXON
PRE -MOVE INSPECTION
EXCAVATION OR FILL
[3 YES
.7 ......
15
13 SETBACK
ME
N 0
NUMBER
DEFICIENCY THIS PROPERTY
Valuation
N�i
Fee
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 authot�
I n;r0e to Comply With city and state laws rtgu-
AT=NTION
APPLICATION APPROVAL
0
Ized agent of the owner.
lating Construction; and In doing the work authorized thereby, no Person
Washington
Tills FEn1%UT
This application is not a permit until
i
will be employed In violation of the Labor Code of the State of
Insurance.
AUTHORIZES
by the Building official or his Dep-
relating to Workman's Compensation
ONLY THE
signed
uty; and fees are paid, and receipt is ac-
NOTE: Permit Limit One Your (Encept DEMOLITIONS which
be
WORK NOTED
knowledged in space provided.
be I. d in ningly days; MOVED -IN BUILDINGS shall OOm'
shall com to
pleted �jjx%eqnths.
tin
Ck 0 tGPNT) DAVID 8
INSPECTION
15IIE-EdIMEIN11515' LTUJ
DEPARTMENT
CITY OF
M.KIDNDS
NOTE: Applicant Subject to Platt Check Fee
PR 6-1107
Tills Ilermit COVOn Work to be done on PrITIKO Property urijur.
Any construction on the public domain (curbs, p1dowliks, driveways,
rum
m"Queas, @tc.) will re4alre sepamte PernI1001001-
...........
WORK PERMIT No.
APPLICATI(�A & Application
it Limit, One Year
MONDS Building Department Perm
CITY OF ED
Plans
in accordance with the accompanying
struct the following work,
APPLICATION is hereb d for a permit to con
rna e
and specif ications:
4- - ......................... Ground Are ................................... No. Stories ............
New/ ..........
WORK Addn. ... ..
.......................
. . ................... Height
.... ...... . ................. Const. Type
...........................
...............................
Plans Submitted ........
.......... r ...... ........ Use Zol� e Zone ...................
LOCATION—Address ... .................................................
. ..................... Sewerage ....................................
dd'n ......................................... ..............................
Recorded Lot. ................... Block. ................... A
�.7
gs;� ........ Zt ...... §Jdps .. ............. .....
Lot Area ........................................ Width ............................ Min. Bldg. Setbacks, Front and . .... 22
J"'49 7
Phoned . ..... .......
............... Address .... .............
....... ..... ....... ... ... r .. ..
owner . .............. ........
....... .......
....... Address ......................................................................... Phone .................
Plansby ...... . .............................................. . ........
................. Phone .............. .......... .......
...................................... Address .......................................................
Bldg. by ......... ...........................................
....................
.........................
...... Address ................................. ...... Phone ............
Plbg. by ...............................................................
Phone................................
........................... Address ........................................................................
Heatingby ...........................................................
Phone................................
Address .......................................
......................... ....
Elect. by ...........................................
.... ................
Remarks . . ......... ..... ....
...............
. .............. �
.............................................................................
.................
..................................................................................
.......... ......................
...............
................................................................
...............................
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with all applicable Codes and State Laws regulating the work.
The above is a correct statement and I agree to comply
'AAddress .......................................................... . .........
;z ....... Date .... Z.
Signed: Owner/AOVPA.
d to compliance with the approved plans
reby approved, subject to the above conditions, an
PERMIT for the above work Is he s thereon.
artment notation
and specifications and Building Dep rERMT FEES
VALUATION
$ ............
Bldg.
Plbg., . . . . $ ................................
$ .....................................
Heat
APPROVED:
Elect. $ ........................................
Date .........
Others. . . $ ............. .............. ...........
BUMDING DEPARTMEN
v3n Dy�, Bldg. 6 f. TOTAL FEE $ .......... ......
By......... Pjkl! ................................. ...........................
I be covered before Inspection and approval.
or City Engineer's inspection shal
NOTES: No work requiring Buil , g Department Engineer prior to construction of all site utilities, such as
Twenty-four (24) hour notice requested. Contact the City
curbs, paving, driveways, sewer, water and street connections.
Owner . ....
e... .. .
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