670351.pdfr I
BUILDING DEPARTMENT
Applicant Fill
PERMIT APPLICATION
Inside Ileavy Lines jOI3
NAM (OR NAME OF BUSINESS)
BID
MAILING ADDREBB
—us
TELEPHONE 14UM A�
HEj
NAME
ADDRESS
TTS
EX
CITY
ELEPHONE NUMBER
C
NAME
ADDRESS
CITY
TELEPHONE NUUMM—BER
STATE LICENSE NUMBER
TY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Your Copies)
at — a 5 'N/ E PI
47
F 0 led S S"':'k A I F
I
no
N Al
0
P
GAS
RESIDENTIAL LINE
DNEW
NON-RESIDENTIAL SIGN
RETAINING
WALL
DEMOLJSH
E] ALTER EXCAVATE PENCE
D OR FILL ( .......... x
E] REPAIR PRE -MOVE swim
INSP. POOL
NUMBER OF
DWELLING
UNITS
N�ATURE OF WORK TO BE DONE
Z
0
PROPOSED UBE
Building abutting streets)
PLOT PLAN (Indicate setbOcks,
t
N
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 rcgu-
luting 00DArUctl0n; 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 Workmell'5 Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days: 51OVED-IN BUILDINGS shall be com-
pleted In six months.)
---
SIGNATURE (OWNNIS ull
TE SIGNED
xa?v C;W 'ea
ho 7
NOTE: Applicant Stibject tol�lan Check Fee
_iwa —Pemilt coven work to be done on private property UNLY.
Any construction on the public domain (curbs. sidewalks, driveways,
marquees. etc.) %vill require separate permission.
KUM
ADDRESS
9 _1L
K I STg
r
.'UT
YARD SEMUSACK ST EET SETBACK
4 - 'JY7 'A
� 1-� - . 1 1 -:25
00351
15 1 M/01V
VA—C;Uff SITE
[] YES 13 NO
,STING STREET R1W ............ FT. DEFICIENCY THIS PROPERTY
DMP. PLA14 ST. R/W ............ FT -
RE ZONE TYPE OF CONSTRUCTION O�n�K JMrAuv
[:] YES NO
'ECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES [3 NO I
,AN CHECKED BY
EMARKS
Valuation Fee Receipt No.
IanCheck No .....................
IUILDING 14 n 0-2-- 0 -D
ILUIMNG
1EAT & GAS LINE
7ENCE
BIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE-,.,
EXCAVATION OR FILL
TOTAL A'310UNT DUE
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt Is aC-
knowledged in space provided.
ECT SIONATUP
INSPECTION DIZ�R'S L ZLE
DEPARTMENT
CITY OF
ED31ONDS
PR 6-1107 FILE
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