670282.pdfBUILDING DEPARTMEN
PERMIT APPLICATION
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Applicant FM
inside Heavy Lines
POSTED ON MOLL MAP NO.: PERMIT
I NUMBER
t--)70282
1
JOB ADDRESS
SIDE YARD SETBACK
USE ZONE
(9 4 1 --j—
aflusair SETBACK
I;O—TAREA
I
REAR YARD SETBACK
5 1 f
" 1*77.A-.0-4
VAU�W Mam
E3 YES 13 NO
—111
?HONA NUMB
e
I/ _2 0 J/ .1
HEIGHT
—
I BUILDING AREA
VARIANCE NUMBER
EXISTING STREET R/W ........... FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ........ ... FT.
REMARKS I'l
ICHECKED BY
ME'THIR SIZE t 13ZRVICE SIZE I CLEARANCE I CHECKED BY
REMARKS 19
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Kxrju t
IASW Description of Property (Show Below or Attach Four Copies)
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PLAN
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ADD
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REPAIR
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NON-RESMENTIArj
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DEMOLISH
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FILL
PRE -MOVE
INSP.
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810
RETAINING
WALL
PENCE
El ( ........ . X .......... Ft.)
swim
POOL
REMAJ
NUMBER OF
DWELLING
UNITS
[3 NO
aPlan
Check No ..................
PROPOMM USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
BEAT & OAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIMM71NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR PILL
TOTAL AMOUNT DUE
I hereby neknowledge, 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 slats laws regu-
ATTENTION
I&ttng 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 PERMT
relzling to Workman's Compensation Insurance.
AU=OM%lrs
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
sball be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In nix months.)
(OWNER OR AGENT) ATESIONED)
INSPECTION
DEPARTMENT
jS:j1`G_9A_TURE
CITY OF
I
EDMO"S
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done on Private property ONLY.
Any construction on the public domain (cnrbm� aldewalksp drivewaysp
numquees, etc.) will require sepamte P6rmI5sI0D-
YES n No
Valuation
APPLICATION APPROVAL
No.
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
FILE
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