670131.pdfPOSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT NUI%IBER 6-70131
Applicant Fin
Inside IleaVY Lines JU13 ADDRESS
PERMIT APPLICATION
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NAME (Olt NAME OF BUBINE118) ETBACK
it STREET SETBACK
E31DE YARD SbTRAC
C9
MAILING ADDRESS VACANT 81
7/� USE ZONE LOT AREA
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0 CITY r] NO
HEIGHT BUILDING A.REA CE NUMBER 04
NAME
-z7-,,r PLOT A ROVED
ADDRESS
STR*W R/w J
CITY TELEPHONE NUMBER EXISMNG STREET R/W44� ........ FT. DEFICIENCY THIS PROPERTY 0
C- 7Z COMP. PLAN ST. R/W4441 .. FT.
REMARKS
NAM
BY
ADDRESS
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METER SIZE BERVICF SIZE CLEARANCE C:jj��
CITY TEL"Nell NE NUMBER
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CITY LICENtilu
STATE LICENSE NUMBER
Tl�Legal Description of Property (anow Below Attach Four Copies)
PERC. TEST PER$4ZZJUMBER
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REMARKS U)
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Q FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
[3 YES &,T�o
SPECIA L INSPECTOR REQUIRED OCCUPANCY GROUP
[3 YES rAw
PLAN CHECKED BY
RESIDENTIAL GAS
Z'--N-EW
ElADD
NON-..
SIGN
RETAINING
ElDEMOLISH
WALL
DALTER
EXCAVATE
OR FILL
FENCE
( .......... x .......... Ft.)
REPAIR
F-1
PRE -MOVE
INSP.
F-1
SWIM
POOL
DWELLING
UNITS
NATURE OF WORK TO BE DONE
I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I lun the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state 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; MOVFD-IN BUILDINGS shall be com-
pitted in six months,)
NOTE.ZAPPlicant Sribt� , ct to Plan Check Fee
This Permit coven work to fm done on private property ONLY.
Any construction on tile public domain (curbs, sidewalks, driveways,
marqu"s, etc.) will require meparate permission.
Valuation I Fee I Receipt NO.
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
AT= NTION
TIUS PE101IT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
ED51ONDS
PR 6-1107
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.
DIRECTOR'S SIGNATURE
DATE
W=
FILE
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