710041.pdfPOSTED ON KROLL MAP NO.: PERMIT
U I L D I N G DEPARTMENT Applicant Fill NUMBER
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Description of Property (Show Below or Attach Four Copies)
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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SPECIAL INSPECTOR REQUIRED GROUP
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NUMBER OF STORIES
NUMBER OF
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Valuation
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PROPOSED USE
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DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby acknowledge that I have read this application; that the In.
formation given 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-
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
THIS PERMIT
This application is not a permit until
relating to Workmen's 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-
shall be completed In ninety days; EIOVED-IN H LDINGS shall be com-
knowledged in space provided.
pleted "six months.)
8i IlE (OWNER OR ENT) DATE 816NED
INSPECTION
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NOTE: Applicant Subject to Plan Check Fee
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PR 8-1107
This Permit covers work to. be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
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marquees, etc.) will require separate permission.
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