690293.pdfPOSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMEN
Applicant Fill
NUMBER
90293
PERMIT APPLICATION,
Inside Heavy Lines
J013 ADDRESS
BUSINESS)
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NAME (OR NAME 9F
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SIDE YARD SETBACK
STREET SETBACK
REAR YARD SETBACK
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TELEPHONE 14UMIJNN'__
us 13 LOT AILEA
VACANT SITE
0 YES [3 NO
"ITT
08
[Ala— 5 X
LIZ 36
HEIGHT BUILUING AREA, VARIANCE NUMBER
I
NAME
I
PLOT PLAN APPROVED
ADDRESS
STREET R/W
EXISTING STREET R/W ........... YT-
DEFICIENCY THIS PROPERTY
CITY
TELEPHONE NUMBEIR
FT.
COMP. PLAN ST. R/W ............ FT-
REMARKS
............
NAME
1%
ADDRESS
I
CHECKED 13Y
CITY TELEPHONE NUMBER I
METM 81ZZ I SERVICE SIZE I CLEARANCE ICRECKED BY
-TER 8
STATE LICENSE NUMBER CITY LICENSE NUMBER C4
REMARKS
T.pe&l Msprintinn. of PrODertv (Show Below or Attach Four Copies) io: 1
D�N_EW
RESIDENTIAL
F1
GAS
LINE
0
NO N-RESIDENTIAL
0
SIGN
RETAINING
DEMOLISH
El
WALL
0 ALTER
0
EXCAVATE
OR FILL
R
FENCE
( x Ft.)
........ . ..........
REPAIR
0
PRE -MOVE
INSP.
El
SWIM
POOL
DWELLING
UNITS
0 YES
TYPE
E] YES [j NO
13JL 'r-,o S-f
.r6 jk)SPer7jj Aj_
rian Check No .....................
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\A/0 A SAO P 4 J__r0 P2.._ 16Y 0 BUILDING
PROPOSED USE PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT & GAS LINE
'ON PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
L7
-]"&
- TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given in correct; and that I am the owner, or the duly 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 Wanhington THIs PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVEDAN BUILDINGS shall be com-
Pleted In six months.)
-ff-I-GNATUIZE (OWNER OR AGENT) DT%7L -SIGNED INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
NOTE: Applicant Subject to Plan Check Fee PH 6-1107
This Permit covers work to be done an private property ONLY.
Any construction on the public domain (carbso sidewalks. driveways,
marquess, etc.) wW require separate Pern12510n.
Valuation
,�_& , #-0
APPLICATION APPROVAL
No.
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.
J� 1,;�9 -6
FILE
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