670104.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
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POSTED ON KROLL MAP NO.: PER IT 670104
NUMBER
AppUc ill
Inside II:t FLInes JOB ADDRESS
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El YES [3 No
EXISTING I STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ........ ... 117.
d_:=0 %I- F
[] YES [] NO
2_�&SIDENTLI
GAS
LINE
F� NEW
I
El NON-RESIDI TIAL
SIGN
ElADD
RETAINING
ElDEMOLISH
WALL
Eq--Jk7CTER
EXCAVATE
OR FULL
0
FENCE
( x Ft.)
E] REPAIR
PRE -MOVE
El
.......... ..........
swim
POOL
INSP.
TUM33ER OF STORIES NUMBER or
DWELLING
UNITS
A
Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GA13 LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application: that the in-
formation 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 ]&We rOgU-
ATTENTION
lating construction; azd In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
TIHS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE
wonK NOTED
shall be completed in ninety days; 31OVED-IN BUILDINGS shall be com-
pleted In six months.)
SIGNATURE- WNE AGE DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EMIONDS
NOTE: Applicant Su4ject to Plan Check Fee
PR 6.1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs. sidowalks, driveways,
marquees, etc.) will require separate permission.
[] YES Ij NO
I
Z
W
04
Valuation Fee —Receipt No.
7
r7_0 � T
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.
DIRECT,qR-S SIGNATU�jp
op,
DATE�
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ecp000 -IV S-1
-RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Lines
Final