700000.pdfTA"
ON IMOLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fill NUMBER -700000
PERMIT APPLICATION Inside Heavy Lines JOB ADDRE88
NAME (OR NAME OF BUSINESS) I z� sr.
.5 exi
TELEPRONIS NU
zpo — ye
TELEPHONE NL
A I
or
E] NEW
_j RESIDENTIAL
D
GAS
LINE
ADD
1:1
11
NON-RESIDENTIAL
SIGN
1:1
D
RETAINING
WALL
0 ALTER
DEMOLISH
EXCAVATE
VENCE
M
OR FILL
F-1
( ........ x ......... Ft.)
REPAIR
El
PRE -MOVE
INSP.
El
swim
POOL
NUMBER OF
DWELLING
UNITS
j
VACANT SITE
13 YES 13 NO
Z
I
VARIANCE NUMBER
PW
EXISTING STREET R/W .......... XT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ........... XT. .......... FT.
[:] YES [3 NO
REMARKS
Mn Check No ................ . ...
BUILDING
PLUMBING
HEAT & GAS LINE
tRETAINING
FENCE
SIGN
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
[j YES [:I NO
Valuation I Fee
No.
I hereby acknowledge that I have read this application; that the in. TOTAL AMOUNT DUE
formation given In correct; and that I am Lhe owner. or the duly author.
Ized agent of the owner. I agree to comply with city and state laws rogu-
tating constructIon; and in doing the work authorized thereby, no person ATMNTION APPLICATION APPROVAL
that I
duly '
"a laws
h
m" "r
0
gu
pa on
by no on
will be employed In violation of the Labor Code of the State of Washington THIS PEnMIT This application is not a permit until
relating to WorkmaWa Compensation Insurance. AUTHORIZES signed by the Building Official or his Dell -
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt Is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be e0m. knowledged in space provided.
pleted In six months.)
31ONATURE (OWNER Olt AGEN DATE SIGNED INSPECTION DIREOTOW�AIGN
DEPARTMENT
CITY OF
EDIVIONMIS
NOTE: Applicant Subject to Plan Check Fee PH 0-1107
Thin Permit coven work to he done on private property ONLY.
Any construction on the public domain (curbs, sidewalks. driveways,
marquees, etc.) will require separate permission.
------- -------
RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough)
Frame 4
i,
Furnace & Fuel Lines
'76
Final
j
o'
rw�
t6bR'D'bF,'fN'S'PECTlONS.'
Date Passed
�'�'Draln'a'
ge
Sewer'
Parking_,,
Landscaping,
Fire Dept.