670318.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR N OF BUSINESS)
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NAME
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Applicant Fill
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rubli'JUL) V94 Anv� -mv "U.; PERMIT
//if I NUMBER 670318
JOB ADDRESS -06
NO n7fx
9
SIDE YARD SETBACK
Mid
BTREET SETBACK
12 V M I tv
HEAR YARD SETBACK
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13SE ZONE
9'�
LOT AREA
VAUANT SITE
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-1
EPHONE NUMBER
MIGHT
BUILDING AREA
I VARIANCE MIMB
E213877NO STREET R/W :M�� ... FT. DEFICIENCY THIS PROPERTY
VE NUMBER COUP. PLAN ST. R/W FT.
0 / RELEARK13
ER
CHEMEP BY
SIZE SERVICE S= LEARJOLNCE 10 33Y
ME NUMBER IC
ENSE Vd-R REMARK8
13 YES
NEW
ADD
ALTER
REPAIR
RESIDENTIAL
LEINON-RESIDENTIAL I
0
F'�
GAS
LINE
SIGN
RETAINING
WALL
PENCE
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POOL
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E-1 DEMOLISH
EXCAVATE
D OR FILL
PRE -MOVE
1:1 INSP.
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Plan Check No .....................
PRUPODED UBE
BUILDING
PLOT
PLAN (Indicate Building setbackA,
PLUMBING
HEAT & GAS LINE
PENCE
F7
SIGN
RETAINING WALL
SWIMMING POOL
N DEMOLITION
PRE -MOVE INSPECTION
�� �2=vo EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge 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 state laws regu.
ATTENTION
lating construction; " In doing the work authorized thereby, no person
will be employed In violation of the Labor Coda of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHOIUZES
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIGNATURE WNER OR AGP7) DATE SIGNED
INSPECTION
e
DEPARTMENT
CITY OF
EDMO"S
NOTE: Applicant Subject to Plan Cbeck Fee
PH 6-1107
This Permit covers work to be done an private property ONLY .
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
YES b No
0
Valuation I Fee
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.7_5�1 4 9 9
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-
Imowledged in space provided.
DAT
FILE
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