670417.pdf4
IRV
rBUILDING DEPARTMENT
Bt
PERMIT APPLICATION
WE 1"
LiAG
Applicant Fill
Inside Heavy Lines
�t. � -1740/
iw or At
rl�
NEW
Li RESIDENTIJ
"
GAS
LINE
NON -REBID] TIAL
F_j
SIGN
RETAINING
0
DEMOLISH
WALL
DALTER
R
EXCAVATE
PENCE
OR FILL
( .......... x .......... Ft.)
REPAIR
1:1
PRE -MOVE
8XVIM
INSP.
POOL
8
NUMBER OF
DWELLING
U14ITS
PERMIT
NUMBER
[3 rES
670417
NO
EXISTING STREET R/W ........... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ....... .... FT. __
El YES [3 NO
Plan Check No .....................
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
PENCE
t
SIGN
N
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-
ATTENTION
lating construction: and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
THIS PERMIT
relaung to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DF.11OLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDIN08 shall be com-
pleted in nix months.)
DATE 81ONED
INSPECTION
DEPARTMENT
CITY OF
ED51ONDS
NOTE: Applic�nt Sitbject to Plats Check Fee
FR 6-1107
This Fern -at covers work to be done on private property ONLY.
Any construction on the public dornain (curbs, sklawalks, driveways,
marquees, etc.) will require separate permission.
Valuation
nL C) 0 Ci
0 YES 0 NO
Fee
9
N
Z
N
APPLICATION APPROVAL
This application Is not a permit until
signed by Uie Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged In Space provided.
Of J - of 09
DATE
FILM
M