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POSTED ON KROLL MAP NO.: PERMIT
DING DEPARMENT NUMBER 670578
I A-11cant II
APPLICATION
Inside Heavy Lines
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USE ZONE
LOT AREA
1
VACANT SITE
0 YES P(NO
ER
HEIGHT
BUILDING AREA
VARIANCE NUMBER
PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
............
0
COUP. PLAN ST. R/W ............ FT. ........... TV.
REMARKS
CHECKED BY
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
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ER
REMARKS
dBER
- TYPE CONNECTION VERIFIED BY
(Show Below or Attach Four Copies)
PERC. TEST PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES [3 NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
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YES NO
PLAN CHECKED BY
NEW
RESIDENTIAL
GAS
El LINE
REMARKS
ElALTER
tEPAIR
NON-RESIDENTIAL I
DDEMOLISH
EXCAVATE
0 On FULL
F_� PRE -MOVE
INSP.
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SIGN
RETAINING
WALL
PENCE
( .......... x .......... Ft.)
SWIM
POOL
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DWELLING
UNITS
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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-
lating construction: and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Wnshington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (EXcept DEMOLITIONS which
shall be completed in ninety days; MOVED -IN' BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plait Check Fee
This Permit covers work it) be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Plan Check No
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
TIUS PER!%IIT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
ED31ONDS
Pit 0-1101
Valuation
o
No.
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 0 F_
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