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720358.pdf
ja.LL t !t s ,1 1 1tj Y NG DEPARTMENT IT APPLICATION ":bD10 OI1/�s .ME C Applicant Fill Inside Heavy Lines 01 ADDRESS 8 4q� /41de_r tSo'. CITY TELEPHONE NUMBER d yn D VL to S 8 STATE LICENSE NUMBER CITY LICENSE NUMBER Legal Description of Property (Show Below or Attach Four Copies) iO GAS ,G O NEW RESIDENTIAL ❑ LINE b4� NON-RESIDENTIAL ❑ SIGN ADD RETAINING ❑ DEMOLISH WALL ALTER EAVAT❑ OR FILL E ElFEN s_..... ..Ft.) REPAIR ❑ N PMOVE SWIM El POOL NUMBER OF STORIES I IO NUMBER UNF MAP NO.: I Pt�EIL .�i�(:J.aid 0� LA U i-e C-i D Y. ❑ YES ❑ NO l'7� EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY COMP, PLAN ST, R/W ............FT. ......._...FT. REMARKS 0 `-ua SPECIAL INSPECTOR REQUIRED ❑ YES Z O OCCUPANCY GROUP PLAN CHEC Y THIS SITE IS LOCATED IN THE REMwRKs TAX SHOULD BE CODED 31 04, NATURE OF WORKTOBE DONE Valuation Fee q� ' �" a t I Plan Cheek No........_.._.._... x BUILDING PROPOSED USE PLUMBING PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT A OAS LINE O FENCE 3©D,(xf SM-1 SIGN / RETAINING WALL l SWIMMING POOL DEMOLITION PRE -MOVE INSPECTION EXCAVATION OR FILL LTOTAL AMOUNT DUE 1 hereby acknowledge that I have read this application; that the m. �- n on given Is correct: and that I am the owner, or the duly author. agent of the owner. I agree to eomD1Y with city and slats Jews roLu- ATTENTION APPLICATION APPROVAL construction; and la doing the work authorized thereby, no person employed In violation of the Labor Code of the State of Washington THIS PERMIT This application is not a permit Lentil to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep- ONLY THE : Per it Limit One Your (Except DEMOLITIONS which WORK NOTED Uty; and fees are paid, and receipt is ac- millet in ninety days: MOVED -IN BUILDINGS shall be com. hnowledged in Space provided. n six o s.) o RE (O RPR A ENT) DATE SIG ED INSPECTION D CTOR' ION R r DEPARTMENT G CITY OF DATE EOMONDS n �I NO E: Applicant Subject to Plan Check Fee � PR allot This PernNQ coyirs work to be done on private property ONLY. Aa7 tonstrucIM19 on the public domain (curbs, sldewalW, driveways, marquees, eta.) will require separate permission.