700544.pdfC9
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NUMBER 700544
UILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines JOB ADDRE8B
NAME
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/4t Q(ELONE NUM�R;7 I I [J YES [3 NO
L-1 --,1, -7, AHEIGHT I BUILDING A I VARIANCE NUMBi
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CITY
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STATE LICENSE NUMBER CIT
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DNEW
RESIDENTIAL
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R
GAS
LINE
1:1
NON-RESIDENTIALJ
R
SIGN
ElA"v
RETAINING
ElDEMOLISH
WALL
ALTER
El
EXCAVATE
OR FILL
FENCE
( x Ft.)
PRE -MOVE
.......... ..........
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YREPAIR
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INSP.
El
POOL
DWELLING
UNITS
IE DONE
Ar_ 6,4-14
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I hereby acknowledge that I have read this application; that the in.
formation given Is 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-
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVEDAN BUILDINGS shall be com-
pleted la 5"onths.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marqueen, etc.) will require separate permission.
/W
STREET R/W
EXISTING STREET n/w ............ FT. DEFICIENCY THIS PROPERTY
"T.
COMP. PLAN ST. R/W ............ FT- ............
REMARKS
E] YES WNO
REMARKS
Valuation
Firm Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
0-0
I
[] YES [3 No
Fee
51
0
AR
Z
No.
hTOTAL AMOUNT DUE Z'r-A/
ATTENTION APPLICATION APPROVAL
THIS PERBUT This application is not a permit until
AUTHORIZES signed by Me Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, find receipt is ac-
knowledged in space provided.
INSPECTION
DIRECTOR'S SIGNAT
DEPARTMENT
CITY OF M=
EDIVIONDS DATE 4t
PR 6-1107 11, a, 76
FILE
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