690030.pdfPERMIT
POSTED ojq__KROLL MAP NO.: NUMBER
6900-30
BUILDING DEPARTMENT ApplIcalIt FIR
PERMIT APPLICATION Inside Heavy Lines _J0_B_&D_D�RE88
NAM (OR NAME OF BUSINESS) _L/.;� Z — 4 co
REET SETBACK REAh YARD SETBACK
_.� �r
SIDE YARD BETB�CK ST
47 __11. . / / -_ I 'I Y, M 0
MAJIUNG ADDRESS 0
U E ZONE LOT AREA VACANT SITE
"7 Z
[3 YES NO
TELEPHONE V MHEn 16 1 1
BUILDING AREA VARIANCE r(UMBER N
CITY ZL 7sz HEIGH
NAME
VED
F
ADDRE 58
87 CT R/W EET R/W .......... FT. DEFICIENCY THIS PROPERTY
EXISTING STR
CITY TELEPHONE IiUhlli�
COMP. PLAN ST. R/W ....... .... FT- ...... 0
REMARKS
1177
X/
Z
C4 ADDRESS
CHEUKED BY
NUMBER
TEL, E
�Y` METERSIZE SERVICE SIZE CHECKED BY
I ;IT
TATE LICJJNJ3E NUMBER ITY LICENSE NUMME" ]CLEARANCE
4,az 778'
opies) REMARK13
Ilk TYPE CONNECTION VERIFIED BY
Legal Description of Pz
[ErRESIDENTIAL
GAS
LINE
0 YES
E] NEW
1
PLAN
1:1
No
SIGN
EKADD
RETAJNTNG
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
PENCE
( .......... x .......... -
REPAIR
PRE -MOVE
INSP.
El
swim
POOL
JUMBER OF STORIES
NUMBER OF
11 DWELLING
UNITS
t
N
I
I hereby acknowledge Mat I have read UMB application; Mat the in.
formation given to correct: and that I am the owner, or the duly author -
[zed 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 Washington
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 mix months.)
31ONATURE (OWNER OR AGENT) DATE SIGNED
>
NOTE: Applicant Subject to Plan Check Fee
TWO Permit covers work to be done On private property ONLY.
Any construction on the public domain (enrbo, sidewalks. drivewaYs,
nuwqueas, etc.) will require separate Permission -
[3 NO
Plan Check NO ...........
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
TIM PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDAKONDS
PR 6-1107
[3 YES a NO
Valuation I Fee I Receipt No.
0
I el� 2 A7 (V r /-/-X -2--,
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his Dep-
uty; and f ees are paid, and receipt is ac-
knowledged in space provided.
M]
110