690028.pdf9
.......... -------
BUILDING DEPARTMEN7 ApplleantFm
PERMIT APPLICATION Inside Heavy Lines
0 1 XU��G 1—DMIES8
P41
mz
- 91*3, /
...........
C
I ON KROLL WAP NU.: PERMIT
NUMBER
/400
DRESS
3a
ARD SETBACK
STREET SETBACK
I �_ I I
� — I '0� , .
6%028
&y1f
3AR
YARD SETBACK
.5 , o)
LCANT SITE
'YES -M NO
LRIANCE NUMBER
t
C�-
PLOT PLAN APvROVED
ADDAZU13
STREET R/W EET R/W DEFICIENCY TH113 PROPERTY
_81ING STR
COUP. PLAN ST. n/w.j�.!Z.x-r. ...... FT. 0
CITY tZ
TELEPHONE NUMBER
REMARKS
Driveway slopes not to exceed those
NAME
-4
indicated on Standard Drawing #103.
04
ADDRESS
tv,
CH
�40 BY
I
CITY
wjsLNri:iONE NUMBER
I
METE R SIZE I SERVICE SIZE
11 q
I CLEARANCE
CIfR=
STATE LICENSE NUMBER
CITY LICENSE NUMBER
19 rp /P/9?
REMARKS
Local Description of I�rqperty (Show Be or Attach Four Copies)
_.-41 �%_- I " 17 �,-/ 7
NEW
RESIDENTLAL
GAS
LINE
NON-RESIDENTIAL
SIGN
RETAINING
WALL
DEMOLISH
EXCAVATE
FENCE
ALTER
OR FILL
( x Ft.)
El
REPAIR
El
PRE -MOVE
INSP.
........ . . ........
SWIM
POOL
rUMBER OF STORIES
NUM13ER OF
DWELLING
UNITS
[] YES
94
to
0
ft
Plan Check No ................
BUILDING
PROPOSED U13M
PLUMBING
PLOT PLAN (Indic -ate Building setbacks, abutting streets)
t
HEAT & GAS LINE
PENCE
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 twhe in-
formation given Is correct; and that I am the owner, or the duty 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 PERMT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOTATIONS which WORK NOTZD
shall be completed In ninety days; MOVE]D-IN BUILDINGS shall be com-
pleted In six months.)
UGNATURE (OWNER Oft -AG DA SIOMED_ INSPECTION
�VNT)
DEPARTMENT
CITY OF
ED31ONDS
NOTE: Applicant Subject to Plan Check Fee PR - 1103
Thin Permit coven work to be done OU private property ONLY.
Any construction on the public domain (curbs, sidewalks, drilroways,
msrqu6e@, ate.) wilt requin separate porminsion.
I
ED
[3 YES 13 NO
Z- +
Valuation I Fee
W
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-
Imowledged in space provided.
—3
FILE 6F- �
0
'All