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USE PERMIT
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BUILDING DEPARTMENT Applicant Fill ZONE NUMBER 150384
SPECIAL INSPECTO
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OCCUPANCY OCCUPANT
GROUP LOAD
PERMIT APPLICATION inside Heavy Lines JOB
REQUIRED
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ADDRESS
NAME (OR NAME
PLAN CHECK D Y THIS SITE IS LOCATED IN THE CITY
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THIS PERMIT
NAME �S L4�` .//''I� (/STREET
1� AS •I 'O 1/ i EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
I, ating la Workmen's Compensation Insurance.
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STATE LICENSE NUMBER CITY LICENSE NUMBER �(/ ( Z
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INSPECTION
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Legal Description of Property (Show Below or Attach Four Copies) STREET AND/OR
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DEPARTMENT
WORK REO'D Cl No
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NOTE Applicmu Subject to Plat: Check Fee
775-2525
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This Permit covers work to be done on private property ONLY.
the dome (curbs, sidewalks, driveways,
N SEPTIC SYSTEM
W APPVD BY CITY ENG. ❑ NO N
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Any construction on public
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T AIS SIL ��LAI V/ 3 �
GASElNEW {U REBIDEN TIAL L NE
�J ❑NON-RESIDENTIAL ❑ SIGN
ADD
❑ DEMOLISH ❑ RETAINING
WALL
❑ ALTER ❑ ORCFILLTE ❑ FENCE
IM
REPAIR MOVE ❑PO
INSPOL
NUMBER OF,((STORIESNUMBER OF
UNITS ING
NATURE OF WORK TO BE DONE
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FIRE ZONE
PLAN CHECK
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SPECIAL INSPECTO
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OCCUPANCY OCCUPANT
GROUP LOAD
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REQUIRED
❑ YES
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PLAN CHECK D Y THIS SITE IS LOCATED IN THE CITY
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formation given le correct; and that I am the owner, or the duty author-
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Ixed agent of the owner. I agree to eomD1Y with Illy sad stab lava rogu-
doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
laling construction; and In
x111 be employed In violation of the Labor Coda of the Stab or Waahfugton
THIS PERMIT
This application 1s not a permit until
I, ating la Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Prmit Limit One Year (Except DEMOLITIONS which
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ONLY THE
NOTED
nLy; and fees are paid, and receipt is ac-
be completed In ninety days; h10VED-IN BB[LDINOS Shan be nom-
WORK
knowledged in apace provided.
plcled Im elX monlha.)
INSPECTION
-SIGNATURE (Ow A NT) D�A^�TE SIG
DEPARTMENT
D REC S IGNA USE
,ED
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CITY OF
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NOTE Applicmu Subject to Plat: Check Fee
775-2525
This Permit covers work to be done on private property ONLY.
the dome (curbs, sidewalks, driveways,
ORIGINAL - File YELLOW - hupeclor
Any construction on public
marquees, etc.) will require separate permission.
PINK - Owner GOLD - A,v5ser