710195.pdfi
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` BUILDING DEPARTIV1ENT I Applicant Fill
PERMIT APPLICATIOPI Inside Heavy Linos IUII
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NEW
CI RESIDENTIALGAS
LINE
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NON-RESIDENTIAL
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SIGN
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RETAINING
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❑
WALL
DEMOLISH.,
ALTER
❑
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PENCEx
nCFILTE
on
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REPAIR
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PRE -MOVE
INSP.
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POOL
iUMBER OF STORIES
•
NUMBER OF
DWELLING
I
UNITS
' R SETBACK I T REE1
t�jlE LOT AI
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
PERMIT
710195
NUMBER
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IACIC REAR YARD dE1 BAl.l<
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BITE
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IVACANT
i] YES i7 NO
1 I l 1
IDEFICIENCY THIS PROPERTY
TY91 P ONNECTION
IVERiFIED
BY
PERC. TEST
+
PERMIT NUMBER
a.
REMARKS
uo
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES i] NO
SPECIAL INSPECTOR REQUIRED
YES NO
OCCUPANCY GROUP
PLAN CHECKED BY
REMARKS
Plan Check No .....................
Valuation
Fee
Receipt No.
BUILDING
PLUMBING
r
BEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
N
ISWIMMI!';, POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read thin 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; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plats Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
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ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY TIM
uty; and fees are paid, and receipt is ac-
WORK NOTED
llnowledged in apace provided.
INSPECTION
DEPARTMENT
DIR . TOR'S am j ATU
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CITY OF
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DATE
EDb10"S
PR 6-1107
FILE
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