690084.pdf- - - - - - - - - --
PosTZD ON KROLL MAP NO.: PER IT
NUMBER 690084
ING DEPARTMENT Applicant Fill
BUILD
inside Heavy Lines JOB ADDRESS
PERMIT APPLICATION
1). 13, p VAilveje:5AL cp- 0
NjUM-(OR NAM Oil) .......... ......
AMID (on N OF RUSIN REAR yjCRD SETBACK
YARD SETBACK STREET SETBACK
V PHO" n5kl
ADDRESS VACANT 131TE
us 0 OT A L
t [3 YES !0
TELEVUU14M riu
I MBER 16
HEIGHT B ING AREA VARIANCE N
vo 7- yi-:- r
PLOT PLA AP OVED
DRESS —4
WV" W THIS PROPERTY
E=S1ftNG / STREET R/W DEFICIENCY
TE COMP. PLAN ST. n/W ............ FT. ............ FT. a
REMARKS
he -tj WIJ E
/J0 z
MMPHONE NUMBER
HI L61 �Au 1b) - 1";r /,4J /r7_ MET= SIZE SERVICE SIZE CLEARANCE CHECKED BY
ITY LAUN14tim "U��
i'SWATZ AILVZ�VN "U=�-R
1010/; 15D F0 M REMARKS
Le ascription of Property (Show Below 6e_Att&Ch Four Copies)
TYPE CONNECT10N VJ1;kU&1ZW By
PERMIT NUMBER
PERC. TEST
ro REMARKS
04
0 :!ZCNNE E OF CONSTRUCTION STREET IMPROVED
ITYP
YES C) NO
SPECIAL INSPEU!,ron REQULRED OCCUPANCY GROUP
CA YES NO
DNEW RESIDENTIAL LINE PLAN CHEC"D 33Y
NON-RESIDENTIAL SIGN 9 "_
F� RETAINING REIE�RKII
DEMOLISH WALL
0 ALTER EXCAVATE PENCE
OR FILL ........ . x .......... Ft.)
F] REPAIR PRE -MOVE SWIM
INSP. POOL
NUMBER OF
DWELLING
UNITS
-WA—TURE OF WORK TO BE DO
Elmc rlew Valuation Fee Receipt No.
z I -Ian Check No ...........
PROPOSED USE BUILDING
PLOT gm/IrIE-18 "UHU1.8 Mu—ttingstreets) PLUM33ING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION On FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; ttat the In-
formation given Is correct; and that I am the owner, or the duly author-
ized agent of tile owner. I agree to comply with City and state laws regu- ATTENTION APPLICATION APPROVAL
lating construction; and in doing the work authorized thareby, no person
will be employed In violation of the Labor Code Of the Slats Of Washington Tiflis rEmirr This applica:Uon Is not a pernlit until
relating to Workman's Compensation 11MIUM13M AUTHORIZES signed by the Building official or his Dep-
ONLY THE uty; and fees are paid, and receipt is ac-
NOTE: Permit rimit One Year (Except DEAIOIATIONS which WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com- lmowledged in space provided.
plated ilk at% months.) INSPECTION DIRECTOR'S SIGN
�SIONATURE (OVrNER OR AGENT) SIGNED DEPARTMENT
CITY OF
DA
EDMONI)s
t subject to Plan Cbeck Fee
NOTE: APPlicauLl PR 6-2107
This permit coven warm W . cone, on privaAe Property ONLY. rum
construction on the public domain (curbs, sidewalks. drivOW&YO,
Any separate permission.
marquees, ate.) wW require