710116.pdf. _._ - --
i PORTED ON KROLL MAP NO.: PERMIT 7 1 I
BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (Gr�vr>ttrnwr
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MAILING DRESS
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TELEPHONE NUMBER
NAME
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CITY
TELEPHONE NUMBER
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ADDRESS
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GAS
NEW
RESIDENTIAL ❑ LINE
❑
NON-RESIDENTIAL ❑ SIGN
ADD ❑ DEMOLISH ❑ WALL RETAIKING
ALTER CE
OR FILL FEN
FILL EXCAVATE ❑ ...x..........Ft.)
❑ REPAIR ❑ INSP. ❑ PWINT
OOL
IUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
t
N
I
N
EXISTING
COMP. I
C] YES
NUMBER D 116
C
VACANT SITE
❑ YES NO
VARIANCE NUMBER
;ET R/W ............FT. DEFICIENCY THIS PROPERTY
ST. R/W ............FT. ............FT.
i] NO
Plan Check No .....................
BUILDING
HEAT &
FENCE
SIGN
WALL
POOL
INSPECTION
IN OR FILL
❑ YES (] NO
Valuation I Fee I Receipt No.
TOTAL AMOUNT
DUE
I
I Alt S 0
O�
l0
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- ATTENTION
APPLICATION APPROVAL
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 THIS
PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance. AUT
ORIZES
signed by the Building Official or his Dep-
ON
NOTE: Permit Limit One Year (Except DEMOLITIONS which we
Y THE
NOTED
uty; and fees are paid, and receipt is aa-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
pleted In six months.)
ECTION
IIGNATURE (OWNEI ENT) DATE SIGNED INS
DIRECTOR'S 81"ATUR
�ri
DEP
RTMENT
;•,� /
DATE
ED
IOND$
NOTE: A,6pli alit S)Ibject to Plait Check Fee
Pa
o_IIOI
This Permit covery work to Ira done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require reparate permission.
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RECORD OF INSPECTIONS
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Date:Pasr�d
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