680012.pdfPOSTED ON KROLL MAP NO.:
PERMIT
680012
Rnignimr. n;PART ENT
A " y I e
NUMBER
pp can C/ T -
PERMIT APPLICATIN inside Heavy Lines JUB ADDRESS I
NAME (OR NAUN 01, BUSINESS)
SIDE 7WRD SE7rBACKJ STRKETSETBACK tat YARD BE 73ACK
o" ty L A A
MAILING ADDItNtill 0
USE ZONE LOT AREA v X6. r SITE
A6. //I -TELEPHONE NUMBER YES NO
CITY
11 IGHT BUIL A VARIANCE NUMBER A
NAME
PLOT PLAN APPROVED
ADDRESS
ST E:ET RIW
CITY TE EXISTING STREET R/W ............ FT. DEFICIE2iCY THIS PROPERTY 0
COMP. PLAN ST. R/W ............ 7r.
NAMIC REMARKS
'ADDRESS C`17
2 1 �. /Y.
METER SIZE I SERVICE SIZE CLEARANCE , CHECMM BY
CITY TE MPHONE NUMBER Iq f f==
/_ "
8 )A-4ef t W MARX
STATE LICENSE NUMBER CITY LICENSE NUMUIUlt
AAA � 0 1 � 6-q !f I � TYPE CONNECTION VERTV BY
Legal Description of Property (Show Below or Attach Four Copies) <_1 (M
P C. TEST PER11;!ZJ4UMBER
LRKS
44
FIRE ZO TYPE OF CON U07ION STREET IMPROVED
YES NO
c)
SPECIAL INSPECTOR REQUIRED OCC ANCY GROUP
[] YES KNO
PLAN CHECKED BY
GAMS
NEW RESIDENTIAL L E REMARKS
ElNON-RESIDENT]AL El SIGN This permit issued subject to supervisiolt
RETAINING
0 DEMOLISH 0 WALL and certified report OR Pilixg-
ALTER EXCAVATE FENCE
1:1 OR FILL EJ ( .......... X .......... Ft.)
REPAIR PRE -MOVE swim
El INSP. El POOL
NUMBER OF STORIES
DWELLING
UNITS
NATURE OF WORK TO BE DONE
t valuation Fee -Receipt No.
Z
0 Pfd6n Check No ............ . .......
t PROP013ED USE
L a R BUILDING
e�
gel \
PI OT PLAN (inalcate Building setbucits, abutting streets) PLUMBING
0 HEAT & GAS LINE
PENCE
t SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In- TOTAL AMOUNT DUE 0
formation given In correct; and that I am the owner, or the duly author.
lzed agent of the owner. I agree to comply with city and state laws regu- ATTENTION APPLICATION APPROV�
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 This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE signed by the Building Official or his Dep-
NOTE: Oermit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com- knowledged in space provided.
pleted In six months.) INSPECTION
SIFyA U tE (0))(NER OR GENT� DATE SIGNED DIRECTOR'S SIGNATURE
f DEPARTMENT
Ay"
&t—.A ? CITY OF
ED31ONDS DATE
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Permit coven work to be done on private Property ONLY.
Any construction On the public domain (curbs. sidewalks, driveways, FILE
marquees, etc.) win reQuare separate permission.
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RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Line
Final