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BUILDING DEPARTMENT
Applicant Fill
PERMIT APPLICATION
Inside heavy Lines
JOB
ADDRESS
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NA.��. ID 014
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' CITY TELEPHONE NUMBER
COMP. PLAN ST. R/W ............FT.
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REMARKS
NAME
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METER SIZE
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OF
—1 GAS YES
NEW RESIDENTIAL LINE ❑PLAN CHECKED❑BYO
NON-RESIDENTIAL DSIGN
ADD ❑ DEMOLISH �, RETAINING REMARKS
ALTER El ORCFILL AVATE FENCE x.......... Ft.)
REPAIR wim
❑ INSP. POOL
LUMBER OF STORIES I NUMBER OF
DWELLING
UNITE
_
Plan Check No .....................
BUILDING
PLUMBING
HEAT do GAS LINE
FENCE
SIGN
RETAINING WALL
N
1
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
PERMIT
NUMBER 710177
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VACANT SITE 'I
YES 0 NO
VARIANCE NUMBER l4
DEFICIENCY THIS PROPERTY
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❑ YES ❑ NO
Fee 1 Receipt No.
t9 0
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TOTAL AMOUNT DUE
I hereby acknowledge that I have read Wle application; that We 1n-
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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.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
Uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; ➢IOVED-IN BUILDINGS shall be com-
ltnowledged in space provided.
pleted In Ix months.)
{IGNA RE (OWNE O A NT) DATE SIGNED
INSPECTION
DEPARTMENT
D TOR'8 NAT
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CITY OF
DATE
EDhiOND$
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
rum
marquees, etc.) will Teguire separate permission.
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RECORD OF INSPECTIONS
Date Passed -
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Foundation ,
Q L7 Plumbing (Partial)
_ 1(Rough)
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..: Frame
Furnace & Fuel Lines
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RECORD OF INSPECTIONS I
l Date Passed .
Drainage
Sewer I. ,.. ,•..:
t Parking —to
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Landscaping
Fire Dept.
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