700296.pdfBUI -DING DEPARTMENT
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I In7PERMIT APPLICATION
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Applicant Fill.
Inside Heavy Lines
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PERMIT
NUMBER
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- / 'i I I [] YES
NO
EXISTING'STREET R,(W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ IT.
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W 4" N k 54,t- fiyvky PERC. TEST PERMIT NUMBER
REMARKS
FIT�� TYPE OF CO STRUCTION STREET IMPROVED
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YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
GAS 0 YES NO
RESIDENTIAL LIN
Q NEW E PLAN CHECKED BY
�6 1 1:1 NON-RESIDENTIAL F� SIGN Kbi
ADD RETAINING REMARKS
0 DEMOLISH El WALL
ElALTER EXCAVATE FENCE
OR FILL E] ( .......... x: .......... Ft.)
r_1 REPAIR PRE -MOVE SWIM
INSP. POOL QS tT T&. 0- 1 A er
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS L�k ST OF Nu 5
NATURE OF WORK T D2 Valuation Fee Receipt No.
ctzz rian Check No .....................
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BUILDING
PROPOSED USE PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT & GAS LINE
PENCE;
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SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In. TOTAL AMOUNT DUE
formation given In correct; and that I am the owner, or the duly author -
lied agent of the owner. I agree to comply with city and state laws regu- ATTENTION APPLICATION APPROVAL
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of tbt, State of Washington TIUS PERMIT This application is not a permit until
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formation g I ve n is co r r e _t.
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lie age 0 t 0 a 0 and Im
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wi I be employed in violati'l
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relating to Workmen's Compenaatlaa Insurance. AUTHORIZES signed by the Building Official or his Dep-
N 0 t Limit ONLY THE
LOTE: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 com. Imowledged in space provided.
pleted In six months.)
UR W E oft
SIGN E (0 N R )R AGENT) D TE SIGNED INSPECTION
A UR IRECTOR'WHIGNATURE
DEPARTMENT
CITY OF
NOTE: Applicant Subject to Plan Check- Fee
PR 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewxy@, FILE
marquees, etc.) will require separate permission.
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