670410.pdfPOSTED ON KROLL MAP
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=M I'E It 6704 10
BUILDING DEPARTMENT
Applicant Fill
PERMIT APPLICATION
Inside Heavy Lines
JOB ADDRESS
NAME (OR NAM OF BUSINESS)
SIDE YARD
STREET SETBAC REAR YARD SETBACK
A IT -ING ADDRESS
—USE _ZONE
Ito go L
LOT AREA
A Qyf,
1
CITY—
LEPHoNm NUMBER
0 YES 0 NO
P&
BUILDING AREA
VARIANC
NAME
PLOT PLAN AFrROVED
ADDRESS
_ITELEPHONE
STREET R1W
EXISTING STREET R/W
............ FT.
DEFICIENCY THIS PROPERTY
CITY
NUMBER
COMP. PLAN ST. R/W
............ FT.
REMARKS
NAIM
411h
CKED 13Y
ra
0 I.F., PERC. TEST
NE TYPE OF C0148TRUCTION STREET IMPROVED
FIRE zo
AMM d
I I [] YES EI 1�
EJ YES 0 NO
19 NEW
RESIDENTLA
0
GAS
LINE
NON-RESIDI TIAL
r
SIGN'
DluTrAMING
DEMOLISH
WALL
ALTER
EXCAVATE
OR F711L
PENCE
( x 11.)
.......... ..........
E] REPAIR
PRE -MOVE
INSP.
Ej
swim
POOL
VU—ji—BER OF STORIES
NUMBER OF
DWELLING
UNITS
Plan Check No .....................
PROPOSED USE
BUILDING
'Indicate
PLOT PLAN ilding setbacks, abutting streets)
PLUMBING
0
HEAT & GAS LINE
PENCE
t
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 to correct; and that I am the owner, or the duly author-
tzed agent Of the owner. I agree to comply with city and state lawn regu-
ATTENTION
lating congtruclion; and In doing the work authorized thereby, no person
will be employed 112 violation of the Labor Code of the State of Washington
THIS PERMT
rel&Ung to Workman's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit Ono Year (Except DE31OLITIONS which
WORK NOftD
shall be completed in ninety days; fIOVED-IN BUILDINGS shall be com-
pleted in six months.)
(ONVNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
(r - e d 11,
CITY OF
E"MONDS
NOT -: Applicant Subject to Plats Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation I Fee
ral
I a. 0 t �.:5 17 fe
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.
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