670130.pdfPERMIT
P 1108TED ON KROLL MAP NO.:
NUM13ER 670130
BUILDING DEPARTMENT Applicant Fin t
/ / .5r - )5
Inside Heavy Lines JOB ADDRESS
PERMIT APPLICATION I
14AMN tUlt NAME OFBIUSINNUS) TA CK
SIDE �ARD BETBACIf STREET SETBACK REAR YARD SET
-ZU—MNG ADDR
EBB rZ
OLTN
USE ZONE LOT AREA
CITY M YES [j NO
TE"PHONE NUMBER N
A VARIANCE
ffLIGHT BUILDING NUMBER
NAMIn
PLOT PLAN APPROVED
ADDRESS
STRVET R/W
EXISTING STREET R/W 19�41 .. FT. DEFICIENCY TBIS PROPERTY
COMP. PLAN ST. R/W ... f��FT. ....
REMARKS
C,
ADDRESS
METF
yK SIZE SERVICE 1831ZE CLEARANCE CHECDNM BY
TELEF)iUNIS 14UMBER
�ItEMARHS
ITY LICENSE NO �ER
11Q
LICENSE NUMBER ER
TYPE CONNECTION VER1%7.F BY
Legal Description of Property (Show Below or Attach Four Copies)
PERO. TEST PERW
REMARKS
. . . . . . . . ....
I= ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES No
SPEUM INSPECTOR REQUIRED OCCUPANCY GROUP
0 YES
[]-NO
PLAN CHECKED -BY
GAS
RESIDENTIAL
LINE REMARKS
ON -RESIDENTIAL SIGN
ADD RETAINING
ElDEMOLISH D WALT
0 ALTER EXCAVATE PENCE
D OR FULL 0 ( .......... x .......... Ft.)
REPAIR PRE -MOVE SWIAI
INSP. POOL
El
NUM13ER OF STORIES NUMBER OF
DWELLING
UNITS
Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
BEAT & GAS LINE
FENCE
t
SIGN
N
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 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 PEIDIIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TRE
WORK NOTED
shall be completed In ninety days; .51OVED-IN BUILDINGS shall be com-
pleted In six months.)
SIGNATURE 0 FR-Oft-AGENT),__�,
DAT SIGNED
INSPECTION
DEPARTMENT
rL
CITY OF
ED31ONDS
NOTE:777icant Subjv�ho Plan Check, Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (Curbs. sidewalks, drivewnys,
marquees, etc.) will require separate permission.
Valuation I Fee
o.
No.
APPLICATION APPROVAL
This application is not a perinit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DIRECTOR'S SIGNATURE
DATE
FILE
IXJ
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(D70 1 -30
CITT., COPY
JA 7