670288.pdfPERMIT
NUMBER 67
F(5707-- TOF
9
MAILING R
USE ZONE
LOW AI�A
VACANT SITE
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-TELEPHONENUMBLR
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YES
V
CITY [
HEIGHT
BUILDING AREA,
VARIANCI D NU
NAME
PLOT PLAFq -APPROVED
ADDRESS
I
CITY TELEPHONE NUMBER
STREET It/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/`W ............ FT.
_1ffM_ARXS
NAME
CRECKE.D BY
ADDRESS
METER SIZE SERVICE SIZE CLEARANCE
CHUCKED BY
Z
CITY
TELEPHONE NUMBER
1
8
REMARKS
f
STATE LICENSE NUMBER
I CITY LICENSE 14UA�Jun
2rNEW
RESIDENTIAL
1:1
GAS
LINE
NON-RESIDENTIAL
I
El
SIGN
D��
�
RETAINING
ElDEMOLISH
WALL
EXCAVATE
FENCE
ALTER
EJ
OR FILL
( x Ft.)
E] REPAIR
1:1
PRE -MOVE
INSP.
E]
.......... ..........
swim
POOL
WMBER OF STORIES
NUMBER OF
DWELLING
UNITS
ZONE I TYPE
(:] YES El NO
PLAN CHECKED BY
REMARKS
Plan Check No .....................
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indiealel Building setbacks, abutting streets)
HEAT & GAS LINE
FENCE
SIGN
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-
Ized agent of the owner. I agree to comply with city and state laws regu-
lating construcuon; and In doing the work authorized thereby, no person
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
I NSPECTION
DEPARTMENT
CITY OF
ED31ONDS
SIGNATURE (OVV_N_ERP1Kr_AGENT)N\ DATE SIGNED
NOTE: Applicant Subject to 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, drivenvays,
marquees, etc.) will require separate permission.
El YES [:] NO
Valuation Foe
No.
3. o 0 j:3.,vq,1
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.
DIRECT2R'S SIGNATURE
, �2 7'
FILE
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