680186.pdfPOSTED ON KROLL MAP NOP:
PERMIT
680186
BUILDING
DEPARTMENT
I NUMBER.
Applicant Fill
PERMIT
APPLICATION
Inside Heavy Lines
JOB ADDRESS
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i
.4, / r - ,1- 40 () - - W -
—/00
EXISTING STREET R/W ............ FT.
COUP. PLAN ST. R/W ............ FT.
� Or rrOpOrty (Show Below or Attach Four Copies)
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J, _P J7
TYPE OF
[] YES [:] NO
:J RESIDENTIAL
GAS
NEW
LINE
NON-I;tESIDENTL4.L
SIGN
ADD
DEMOLISH
RETAINING
WALL
ALTER
EXCAVATE
on PILL
PENCE
( X Ft.)
REPAIR
PRE -MOVE
INSP.
........ . ..........
swim
POOL
DWELLING
UNITS
[] YES
SETBAOX
[3 NO
[UMBER
DEFICIENCY THIS PROPERTY
............ PT.
[3 YES [3 NO
Z
N
Z
Aj
Valuation Fee Receipt No.
Plan Check No .....................
PROPOSED USE
-
BUILDING
PLOT PLAN (piffleate l3ullairig setbacks, "uttin g I streets) 1A
PLUM13ING
0q
.
a
HEAT & GAS LINE
fy"100:5 1?ee
buT1
PENCE
SIGN
N
RETAINING WALL
lee)
SWIMMING POOL
DEMOLITION
A
I I
PRE -MOVE INSPECTION
EXCAVATION OR FILL
ZJL w,
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
10
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 lawn ngu.
ATMNTION
APPLICATION APPROVO
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
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt Is ac-
shall be completed In Wooly days; MOVED -IN BUILDIINOS shall be com-
knowledged in space provided.
pleted in six months.)
SIGNATURE (0 ER 01�)AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
DIRECTOR'S SIGNAT�U.'
CITY OF
.....
ED31ONDS
DATE
NOTE: Applicant Su j ct to Plan Check Fee
PH 6-1107
This ]Permit covers work to be done on private property ONTY.-
Any construction on the public dornWn (0=112, sidewalks, driveways,
FILE
cuarqueesp etc.) will require separate permission,