670108.pdfppl�
'%TPILDING
DEPARTMENT7AppUcant
Fill
PPLICATION
InsIde 11cavy Lines
1118 Ines
cavy
MAKE (OR NANTE OF 131JUINNUH)
J�
�ju tj -roe)kl
1Z 11M
MA NG ADDRESS
14
TE—LEPRONE NUMBER
CITY
TELEPHONE NUMBER
NAME
PAUL
?k\4
ADDRESS
!R44 P I-D
CITY
TELEPHONE NUMBER
'F_ 9 yj L% mps
41D
P P !g-_ 9 57
STATE LICENSE NUMBER
72-'l
CITY LICENSK NUMBER
-Legal Description of Property (Show Below or Attach Four Cople9)
7—
1�
L
Z
F-RESIDENTIAL
1 M
GAS
LJNE
NEW
ADD
10 NON-RESIDENTIAL
SIGN
RETAINING
MDEMOLISH
WALL
EXCAVATE
FENCE
ALTER
F� OR FILL
El
( X Ft.)
REPAIR
PRE -MOVE
1:1 INSP.
.......... ..........
swim
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
C Iq J? 9 r_.
PERMIT
NUMBER 6-70 108
S."01 f'. * — 41�
— '-K Z-3- f) �c
BACK i STREET SETBACK
I 10 YES [] NO
I TITTITT)ING AREA I VARIANCE NU
,AN APPROVED
EXISTING I STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ IT. ....... .... FT.
RE- MARKS
CHECKED BY
CFE CONNECTION VERIFIED BY
FIRE ZONE TYPE OF CONSTRUCTION I STREET IMPROVED
r] YES [:I NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[:] YES [:] NO
PLAN CHECKED BY
REMARKS
EPROPOSED
Plan Check NO .....................
USE
BUILDING
PLOT PLAN (Indicate i3tiumni; setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FFNCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
1 hereby acknowledge that I have read this application: that the In-
formation 61ven Is 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
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIGNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
Q
W� //C, ='Zk
� -31.) '/
DEPARTMENT
c
�_ -
CITY OF
ED31ONDS
NOTE: Applicant Subject to Plan Chech, Fee
PR 0-1107
This Permit col-cre work to be done on privnte property ONLY.
Any construction on the public domain (Curbs. 81dowallEg. driveways.
marquccs� etc.) will require separate permission.
Fee
0' 1 '7, -5—
CZ
Z
Z
I
0
Z
Z
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.
VIO _'11IG 2
DATE
Film
4