670297.pdfrA
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BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (0 t
7ANAmE O"Ous"N73)
-7 PERMIT
n 37O—WrED ON KROLL MAP NO.: NUMBB71 670297
AppUcant FIU
Inside Heavy Lines 3013 ADDRESS
I -7f] 4�- 2 � 6 A S, A),
IS— 2, -? (. A S-_ W -
_r 1j),;sL I YK L �5_
6 Wdr,
F-1 NEW
ED RESIDENTI.0
0
GAS
LINE
El
NON-RESIDI TIAL
F�
SIGN
r-1 �Wu
itETAiriiriG
DDEMOLISH
WALL
ElALTER
EXCAVATE
FENCE
D
OR FILL
D
( x Ft.)
REPAIR
1:1
PRE -MOVE
INSP.
.......... ..........
swim
POOL
IUMBER OF STORIEll
NUMB R OF
DWELLING
UNITS
USE ZONE LOT AREA VACANT 8 7E
E]YES El NO
VARIANCE NUMBE
i;��S!F17NG'STREET R/W ............ FT. DElITICIENCY THIS PROPERTY 0
COUP. PLAN ST. R/W ............ FT. ....... .... FT.
REM.ARHB
CHECKED BY
rA
METER SIZE I SERVICE SIZE I CLEARANCE CHECK BY
REMARKS
[] YES
Z
Plan Check No .....................
PROPOSED USE
BUILDING
Q PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge Mat 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 state laws regu-
ATTENTION
lating construcUon; and In doing the work authorized thereby, no perion
will be employed in violation of the Labor Code of the State of Washington
TIHS PERMIT
relaUng to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DE31OLITIONS which
WORK NOTED
)v
shall be completed In ninety days; 107ID-IN' BUILDINGS shall be com-
pleted In six months.) f
WNER OR AG
E S
INSPECTION
DEPARTMENT
IDA
Z C:Z
CITY OF
ED31ONDS
NOTE: Applican Subject to Plan Check Fee
Fn 6-1107
This Permit covers work to be done on private property ONLY.
Any constructlun on the pubtle domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
FE_Z�NNLUI
I _5�00 I 39Z
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.
FILE A71 C_
I