700006.pdfI POSTED
BUILDING DEPARTMENT Applicant Flu
PERMIT APPLICATION Inside Heavy Lines -SGj3ADI:
NAM 0 42C
C4 NA (OR C
K)C' SIDE YJ
KAI
USE ZC
I I TELEPHONE NUM—BER
%1 &0 QE� , VO Q a
TELEPHONE NUMBER
2,-7
ITELEPHONE NUMBER
iperty (unow ijeiow or AURM tour uopicn;
NEW
ALTER
REPAIR
RESIDENTIAL
NON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
INSP.
E]
GAS
LIND
SIGN
RETAINING
WALL
PENCE
( ........ . x . ........ Ft.)
swim
POOL
4UUBER OF STORIES
NUMBER OF
DWELLING
UNITS
MAP NO.: PERMIT
NUMBER _100006
76
0 YES 0 NO
EXISTING I STREET R/W ... ........ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............
REMARKS
BY
L
REMARKS
FIRE ZONE I TYPE OF CONSTRUCT
1 113 YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[] YES (3 NO
PLAN CHECKED BY
Plan Check No ............ . .......
BUILDING
PLUMBING
SWIMMING POOL
DEMOLITION
pR.E-MOVE INSPECTION
EXCAVATION OR FILL
HEAT & GAS LINE
FENCE
SIGN r10
tRETA.INING WALL
N
I I hereby acknowledge that I have read this application; that the in-
formation given to correct; and that I am the owner, or the duly author-
L
Ized 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
r Lit
elating to Worlimen's Compensation Insurance.
I ng
0
LNOTE: Permit Limit One Year (Except DEMOLITIONS which
T1
shall b, completed In ninety days; MOVED -IN BUILDINGS shall be com.
- I
PI't, I
pleted In six months.)
DATE SIGN �D
ONAT
U;c� (_/Z1 'V/_Dfj� A (1?--[ 7
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will reQuIra separate peradsallon.
via
TOTAL AMOUNT DUE 1 1 :2, 6"ej
No.
ATTENTION
APPLICATION APPROVAL
Tfus rERI%UT
This application Is not a permit until
AUTHORIZES
eigned by the Building Official or his Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DIRECTOR'S
DEPARTMENT
01
CITY OF
EDMO"S
PU 91-1107
FILE
t