690344.pdfPOSTED ON KROLL MAP NO.: PERMIT 44
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BUILDING DEPARTMENT Applicant Fill
Inside Heavy Lines
JOB ADDRESS
PERMIT APPLICATION
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NAME (OR NAME OF BUSINESS) 3 /-�o
SIDE YARD3VETBACIC STRINGT UNT)JAVA REAR YARD li3ETBACK
dx Lt/ — I , -
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NO ADDR
or
410 USE ZWN_ff___ LOT AREA VACANT SITE
CITY TELL'rHoNgl NUMBIaR 17, 3 YES NO
11EIGHT BUILDING AREA VARIANCE NUMBER 04
NAME I I
b, I lz�
41 ADDRESS -- ' ' / 1 f
I I CITY I TELEPHONE NUMBER
ADDRESS
Legal Description Of Property (Show Below or Attach Four Copies)
3
RESIDENTIAL
GAS
LINE
NEW
:T
NON-RESIDENTIAL
SIGN
ADD
RETAINING
WALL
DEMOLISH
EXCAVATE
FENCE
ALTER
OR FULL
( x Ft.)
REPAIR
PRE -MOVE
INSP.
........ . ..........
SWIM
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
EXISTING I STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ........ ... FT.
FIRE TYPE OF CO�I�UCTION STREET IMPROVED
I U I Ej YES NO
SEPT TAT INSPECTOR REQUIJIM D OCCUPANCY GROUP
(:] YES �19 NO 1 -7�-
yx 140
Plan Check No .....................
BUILDING
PROPOSED USE
PLUMBING
PLOT PLAN (Indicate
9 TO A
1-3
Building setbacks. abutting streets)
y /4 /;F b
t
N
HEAT & GAS LINE
PENCE
SIGN
I
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
formation given Is 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 ATTENTION
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT
a
y
h
u
a In"
thor-
0 u
a]
n ws P r r g on
ffa oble gton
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
14
NOTE: Permit Limit One Year (Except DE31OLITIONS which WORIE NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In zlx months.)
INSPECTION
3!1�qAATURE (OWNER OR AGENT) DATE SIGNED
DEPARTMENT
CITY OF
ED51ONDS
NOTE: Applicant Subject to Plan Check Fee PH 6-1107
This perealt covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways.
nuLrquees, etc.) will require separate permission.
Valuation
1 3, &6 1 ��/
Z
Cd
No.
APPLICATION APPROVAL
This application Is not a perntit until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE