660549.pdf111
BUILDING —_ DEPARTMENT �j mApplIcant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
ca y / G
MAILING ADDRESS
,'7 17 /) ?7 - j n
a
or
S6,(J,
SPRONN NUMBER
2A21, S_ 3 0 6
luxi-
_XftL lie
RESIDENTIAL
�/,GAr
P
LINE
E] NEW
[ 1:1
NON-RESIDENTIAL
D
SIGN
FMV ADD
H
rAINING
WALL
DDEMOLISH
ALTER
0
EXCAVATE
OR FILL
FENCE
.......... x .......... Ft.)
REPAIR
F-1
PRE -MOVE
INSP.
swim
POOL
NUMBER OF
DWELLING
UNITS
klq_p�
ON KROLL MAe 14U.; PERMIT
ILL NUMBER
RESS
te)
660549
[] YES 13 NO
i;�_S!�17NG__,SYREET R/W ............ IrT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ...... ... XT.
0 YES 0 NO
Plan Check No .....................
BUILDING
ate Building Setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the in-
format4on given to correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
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
TIUS PERMIT
relating to Workman's Compensation Insuranoe.
AU'nIORIZES
ONLY 'THE
NOTE: Permit Limit One Year (Except DE51OLITIONS which
WORK NOTED
shall be Completed in ninety days; 31OVED-IN BUILDINGS shall be com-
pleted in nix months.)
RGITATURE -(OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
Wd
ilet) S If
7
.0?
CITY OF
ED51ONDS
N�O74. Applicant Snbject to Plan Check Fee
Plt 6.1107
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways.
marquees, etc.) will require separate Permission.
13 YES 13 NO
Valuation Fee
1-5-0
z
W
No.
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Itnowledged in space provided.
M
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FILE
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