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ARTMENT I Applicant Fill
ICATION inside Heavy Lines 70-
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CITY LICENUE IWAL"Mm
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P RESIDENTIAL
El
GAS
LINE
PNEW
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NON-RESIDENTIAL
0
SIGN
ADD
F�
0
RETAINING
WALL
DEMOLISH
ALTER
El
EXCAVATE
OR FILL
FENCE
( ......... -1 ..........
El
REPAIR F-1
PRE -MOVE
INSP.
SWIM
POOL
IUMBER OF STORIES
I NUMBER OF
DWELLING
UNITS
rrk_Lll�_
—
TN _XROLL MAP NO.: I PERMIT b7UUt
NUMBER
IESS
I () , I /A
RD SETBACK I STREET SETBACK
IREAR YARD
[:] NO
-i;TREET R/w ZZ).. FT. DEFICIENCY THIS PROPERTY
EXISTING STREET R/W I� ......
cOMP. PLAN ST. R/W C9.252FT-
ITE—BLARKS
-5-447 7- /�/ �c 7"1
Oa 5-
CHECKED BY
YES
L;
PR FOS USE
Plan Check No .....................
BUILDING
PLOT —PLAIN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
_A
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknnwledgo that I have read this application; that the in.
formation given to correct; and that I not the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu- ATTENTION
In.ting 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
relating to Workmen's Compensation Insurance. AUTHOR11ZES
ONLY THE
NOTE: Permit Limit One Year (Except DF31OLITIONS, which WORK NOTED
51hall be completed in ninety days: MOVED -IN BUILDINGS shall be com-
pleted In six months.) INSPECTION
Q TURE (OWNER 0 A DATE IGNED
N DEPARTMENT
CITY OF
ED31ONDS
NOTE: Applicant Sitbject to Platt Cbeck Fec PR 6-1107
_Fh-15perntit coven woric to he done on priVnte property ur��x.
Any construction on the public domain (curbs, Pildewalks, drivewaYs.
marquees, etc.) will require separate permission.
Valuation
/ r7
[] YES
Fee
7.
610 1
I �_ 7 ��)() I
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-
knowledged in space provided.
DATE
_5
FILE
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