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BUILDING DEPARTMENT AppllPmt FW
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ATTENTION
PERMIT APPLICATION Inside Heavy Linea
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THIS PERMIT
This application Is not a permit until
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
relating to Workmen's Compensation Insurmce.
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REQUIRED YARDS
PROPOSED YARDS
NAME
AMOUNT DUE
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LEOAI. LOT VAXfANCE OR CONDITIONAL USE
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formation Elven Is correct; and that I am the owner, or the duly author.
YES MIT
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(zed agent of the owner. I agree to comply with city and state laws regu•
ATTENTION
PLANNING DEPT. APPROVAL DATE:
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STREET R/lV
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THIS PERMIT
This application Is not a permit until
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
relating to Workmen's Compensation Insurmce.
NAME
signed by the Building Official or his Dep -
COMP. PLAN ST. R/W ............FT. ............PT.
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ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is aC-
REMARKS
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CHECKED BY
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METER SIZE SERVICE SIZE CLEARANCE
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STATE LICENSE NUMBERCITY
LICENSE NUMBER
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REMARKS
c ark to be done private property ONLY.
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Any construction (c sidewalks, drivewvy
Any tonttructlun an 11"a public
Legal Description of Property (Show Below or Attach Four Copies)
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TYPE CONNECTION VERIFIED BY
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PERMIT NUMBER
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NEW
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PLAN CHECKED Y THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
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REMARKS SHOULD BE CODED 31.04.
ElDEMOLISH
WALL
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REPAIR
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INSP.
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NUMBER OF STORIES NUMBER OF
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UNITS
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NATURE OF WORK T EeeD��ONE
Valuation
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Plan Cluck No .....................
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AMOUNT DUE
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DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
......///
formation Elven Is correct; and that I am the owner, or the duly author.
AMOUNT DUE
I hereby acknowledge that i have read thisapplication; that the In.
formation Elven Is correct; and that I am the owner, or the duly author.
(zed 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 Der.on
w81 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 Insurmce.
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 Waety days; MOVED -IN BUILDINGS .ball be cam•
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plaod In sl: months.)
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AT 3 (OWNER GENT DATE 816NED
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NOTE: Applirafft Subject to Plan Cbeck Fee
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c ark to be done private property ONLY.
Any construction (c sidewalks, drivewvy
Any tonttructlun an 11"a public
FILE
S
"ulre ecarat,
marnuret, else will rramre separate naadt.lon.