670220.pdf.............. - ------
POSTED ON KROLL MAP NO.: PERMIT
Applicant NUMBER 670220
BUILDING DEPARTMENT Fill
F
1181 (:t Linleg
Inside Heavy Lines jog AJDDRE13B
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS) 77 1 W/
CK REAR YARD SETBACK
elce, S
Y-)
SIDE
USE
YARDB
ZONE
BACK
1
STREET BET13A
LOT AREA
I
0
VACANT SITE
I
G ADDRES13
'aR(e! WF-37-
TELEPHONE NUMB" 0 YES 0 NO
A J�� c- HEIGHT BUILDING AREA VARIANCE NUMBER
.0
ADDItESS
-C-1-TY
TELEPHONE NUMBER
STATE LICENSE NUMBER
CITY LICENSE NUMBER
LegaltFescription of Property (Show Below or Attash Four Copies)
ol-
0
czao
Z
NEW RESIDENTIAL
NON-RESIDENTIAL Q
ElDEMOLISH 0
ElALTER EXCAVATE
0 OR FILL
r_� PRE -MOVE
REPAIR INSP. r_1
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( .......... x .......... Ft.)
swill
POOL
DWELLING
UNITS
t
N
I
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 uuthor-
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; 31OVED-IN BUILDINGS shall be com-
pleted In mix months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private Property ONLY.
Any construction an the public domnin (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
PLOT PLAN APPROVED
STRENT R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ...........
REMARKS
CHECKED BY
METER SIZE I SERVICE SIZE I CLEARANCE JCHECKR BY
REMARKS
TYPE CONNECTION VERIFIED BY
PERO. TEST PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
El YES 13 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
0 YES E3 NO
PLAN CHECKED BY
6Q;Q&a
Valuation
Plan Check No .....................
BUILDING 4)
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
No.
TOTAL AMOUNT DUE I I ::? cr-) !A
ATMNTION APPLICATION APPROVAL
Tills PERMfT This application is not a permit until
AUTHORIZES
ONLY THE signed by the Building Official or his Dep-
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION DIRECT R'S SIGN E
DEPARTMENT
CITY OF
ED31ONDS
PR 6-1107
FILE
I
OUT
5 1 1 vftb L
c
RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Llnes�—�'
Final .2 - :2/, 76 *.,v,