740640.pdfj`dd7' 37
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RETA3NING
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PERMIT APPLICATION Inside IleaVY Lines
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NUMBER OF STORIES NUMBER OF
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REMARKS Driveway slopes not to exceed those
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ADDRESS
indicated on Standard Dwg. No. 103
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PRE -MOVE INSPECTION
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F C17'Y TELEPHONE NUMBER
CHECKED BY
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CLEARANCE CIE
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6770REMARKS
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I hereby acknowledge that I have read this application; that the In.
Legal Description of Property (Sho Below or Attach Four COP—)
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formation given Is correct: And that I — the owner, or the duly author-
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TYPE CONNECTION VERIFY BY
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latingconstruction; and In doing the work authorized thereby no person
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will be employed In violation of the Labor Code of the Slate of Washington
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PERC. TEST PERMIT N MBS
relating to Workmen'a Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
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ONLY THE
WORK NOTED
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,hall be completsilAn ninety day.. MOVED -1N BUILDINGS shall be corn•
kn wledged apace provided.
!N AiiC° Io @ (eC .INS 179 MT
REMARKS �—
SIONATUI WN • O l ENT) .ATE eIONED
INSPECTION
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NUMBER OF STORIES NUMBER OF
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NATURE OFF WORK TO DONE
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Receipt No
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BUILDING
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PLUMBING
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HEAT & GAS LINE
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DEMOLITION
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PRE -MOVE INSPECTION
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EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
formation given Is correct: And that I — the owner, or the duly author-
Ized agent of the owner. I agree to Comply with Illy and elate laws regu-
latingconstruction; and In doing the work authorized thereby no person
will be employed In violation of the Labor Code of the Slate of Washington
TI.S PERMIT
This application is not a permit until
relating to Workmen'a 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 -
,hall be completsilAn ninety day.. MOVED -1N BUILDINGS shall be corn•
kn wledged apace provided.
pleted In eta he.)
SIONATUI WN • O l ENT) .ATE eIONED
INSPECTION
IR C 8 I AT—E
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DEPARTMENT
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CITY OF)
-
EDDIOND3
DATE
NOTE: APP1ican1 nbjrrt to Plarl Cbrek Fre
775-2525
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This 1•ertnll n work to he done on private property ONLY.
Any construction an the public dumaln (Curbs, sidewalks, ArR•eways,
FILE
m urqueee, rte.) will require ,eparats p.—I.110".
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