670093.pdfI
�1 POSTED ON KROLL MAP NO.: PERMIT
NUMBER 6J70093
BUILDING DEPARTMENT Applicant Fill ggm.�
insidi JOB ADDIFE-68 F,
DCDMIT APPIWATI N FF Wf
NAME (Olt NAME DFIsUBINEBS)
J�
MAILING "DUNbb
CITY NUMBER
d 127 P AV 4/5
E
VAnANT SITE
USE Z6NE LOT AREA ACAXCE AW
I I [:] YES [3NO
I � I MIILMNQ AREA
RESIDENTIAL
UA
DNEW
NON-RESIDENTIAL
IG
0:
81 I
0
RETAINING
WALL
DEMOLISH
ALTER
E]
EXCAVATE
OR FILL
D
FENCE
( .......... X .......... Ft.)
M REPAIR
1:3
PRE -MOVE
INSP.
SWIM
POOL
MUMBER Or STORIES —NUMBER
OF
DWELLING
UNITS
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-
Ized agent of the owner. I agree to comply with city and slats 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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
1IGN5:101 :Z (0i,.11JER Olt AGENT) '41 DATE SIGNED
7
NOTE: Applicant Subject to Plats Check Fee
This Permit euvers work to be done on private Property
Any construction on tba public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
I...— �/ ..
EXISTIN STREET R/W ........... XT- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ....... .... 1".
REMARKS
rx
I 'CHECKED BY _1Z
FOILLOUNE—EAM
0 YES [:1 NO
N
valuation Fee
Receipt No.
Plan Check No .....................
BUILDING
3_2
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
o
ATTENTION APPLICATION APPROVAL
TIUs rERMIT This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
uty; and fees are paid, and receipt is ac-
I
WORK NOTED
knowledged in space provided.
INSPECTION D YR'.:�'SIGN 540RE
DEPARTMENT
CITY OF
ED51ONDS DATE
PR 6-1107
FILE
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