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DING DEPARTMENT Applicant Fill
MIT APPLICATION Inside Heavy Lines
InU WAmm nr 1411AINIMED
or
0
P_R_�ESIDENTIAL
El
GAS
LINE
ElNEW
1
1:1 NON-RESIDENTI&L
SIGN
D
RETAINING
WALL
ElDEMOLISH
DALTER
EXCAVATE
D OR FILL
PENCE
I x Ft.)
.......... ..........
REPAIR
PRE -MOVE
Q INSP.
El
SWIM
POOL
TUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
ON KROLL MAP 96�i PERMIT
NUMBER 6-7 0 1 '*1 0
YES E3 NO
- - ___ - - I - -
EM877NG STREET R/W ........... XT- DEFICIENCY TIUS PROPERTY
COMP. PLAN ST. n/W ............ FT. ........ .. in.
0 YES
TYPE OF
[3 NO
Plan Check No .....................
PROPOSED USE
BUILDING
PLUMBING
_FL_oT PLAN (Indicate'13ulldlng setbacks. abutting streets)
HEAT & GAS LINE
'.
FENCE
SIGN
CA
(.3
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 In correct: and that I am the owner, or the duly author-
JZed agent of the owner. I agree to comply with city and state laws regu,
ATTENTION
latlng 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 Insuranct.
AUTIIORKZES
ONLY THE
NOTE: Permit Mmit One Year (Except DEMOLITIONS which
WORK NOTED
gha]l be completed in ninety days; JilOVED-IN BUILDINGS shall be com-
pleted In six months.) -
INSPECTION
3IONATURE (OWNER �1)
DATE SIGNED
DEPARTMENT
ZUItA
CITY OF
ED31ONDS
NOTE: Applicant subje4ilo Plan Check, Fee
PR 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewmYs,
sanrquor", etc.) will require separate permission.
[:] YES [3 NO
Z
Valuation Fee Receipt No.
0
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.
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