HomeMy WebLinkAboutsyrbu grading license appGRADING
LICENSE
APPLICATION
1111111111
City of
&ww
Development Services Division
1055 South Grady Way — Renton, WA 98057
Phone:425-430-7200
www.rentonwa.eov www.MyBuildingPermit.com
1. Job Site Address: q l'7 c cwx.: S
2. King County Tax Assessor Number: S =' e)n t 2- 1
3. Description of work to be performed: i_ iEAA 0c>jE�77 < 4116 Ca g.` C)&RDS (rr,
4. Value of work to be performed:
S. Cubic yards involved: � ! l- o Square footage of property: qo l&
6. Tenant Name (if Commercial or Multi -Family):
Suite/Room #:
7. Contact Person: Phone:? -- v l�f Email: d6qAXS<:,y(_111efi�R.lEm
(This is the person we will contact if we have questions or when the permit is ready to issue.)
8. Contractor's Name: j T� b Phone:
Street Address:
City/State:
9. State of Washington Contractor's License # (Required):
10. Contractor's City of Renton Business License # (Required):
Zip:
11. Property Owner: �1 {� f ���4 R&L Phone: 20 Y �8 j
Street Address: JFyyr[Sr�- �� City/State:GN f� �a% Zip: S
"Over 500 cubic yards: Please contact the Development Services Division at (425) 430-7200 for an application and
information on requirements and procedures.
I certify that the information on this application furnished by me is true and correct and that the applicable
requirements of the City of Renton will be met. I understand that this application is valid for one year from the
application date. If a permit is not issued during this time period, the application will become void. This application does
not constitute a permit to work. Work is not to commence until the building permit is posted on premises where work is
to be performed. Certification is hereby rendered that no work is to be done except as described, and that all work shall
conform to the applicable codes. Work in public rights -of -way and/or utility easements are not authorized under this
application.
Applicant's Signature:
Date:
H:\CED\Data\Forms-Templates\Self-Help Handouts\Building\GradeApp.docx