690399.pdfUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Ifeavy Lines
4AMM (OR NAME OF HUSINEMS)
�gv.Fxt )., H 0 C-�) Aed
AD DICLUS
1ITY TELEPHONE NUMBER
3; - r1141 0 At j r &')-g 6 4 1 1
PERMIT
IROLL MAP NO.: NUMBER
PLTBACK I STREET SETBACK REAR 31�f SETBACK
I I . In " / I i
E3 YES [] NO
PLOT PLAN APPROVED
ADDRESS
STREET R/W
CITY TELEPHONE NUMBER EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
IT "T.
COUP. PLAN ST. R/W ............ F . ............ I a
REMARKS
NAME
rl , S W, Cd A
ADDIVE118
7/ V-6 9 CHECKED BY
CITY TELEPHONE NUMBER
a ///LCI 60 ap _S A,4 �_741- q- MrTER SIZE SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENSE NUMBER CITY LICENSE NUMBER C4
REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
dip 46 J74 et 5 TYPE CONNECTION VERIFIED BY
PERC. TEST PERMIT NUMBER
7, e2
14
REMARKS
FIRE ZOVE TYPE OF CO TRU;CVT1 N STREET IMPROVED
YES NO
SPECIAL INSPECTOR RDQUIRED OCCUPANCY GROUP
C] YES
GAS )(NO
RESIDENTIAL LINE PLAN CHECKED BY
14EW
NON-RESIDENTIAL SIGN
ADD RETAINING REMARKS
ElDEMOLISH El WALL
DALTER EXCAVATE PENCE
OR FULL ( .......... X .......... Ft.
El
ElREPAIR PRE -MOVE SWIM
INSP. POOL
N NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE Valuation Fee Receipt No.
Plan Check No .....................
r
BUILDING 7`7 ie:� 0
PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting d*eets) HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVAIrION 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-
lzed agent of the owner. I agree to comply with city and state lewd regu-
ATTENTION APPLICATION APPROVAL
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 PER311T This application Is not a permit until
relating to Workmen's compensation Ituntroulce. AUTHORIZES
ONLY THE Signed by the Building Official or Ms Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which uty; and fees are paid, and receipt is ac-
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com- Imowledged in space provided.
pleted In six months.)
RIB BIG
SIGNATURE (OWNER-UH. AGENT) DATE SIGNED INSPECTION DIRECTO/, N7,6
DEPARTMENT
CITY OF
DATE I
EDNIONDS
NOTE: Applicant Subject to Plan Check Fee PR 0-1101
This Permit covers work to be done on private property ONLY.
Any construction on file public domain (curbs, sidewalks, driveways, FILE
nuLrquees, etc.) will require separate permission.
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