700039.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
10
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F� NEW
RESIDENTIAL
GAS
ADD
NON-RESIDENTIAL
LJNE
SIGN
RETAnUNG
DEMOLISH
WALL
I
ALTER
EXCAVATE
OR FILL
FENCE
I X Ft.)
REPAIR
PRE -MOVE
INSP.
... . ... . . ........
swim
POOL
DWELLING
UNITS
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-
tzed 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
relating to WorkmeWs Compensation Insurance.
NOTE: Permit Limit One Your (Except DEMOLITIONS which
Shall be completed In ninety days; MOVED -]IN BUHMINGS shall be oom.
plated In SIX Months.)
NOTE: ApPlicant subject to Plan Check Fee
This permit coven work to be done on Private property ONLY.
Any constractlon on the public domain (curbs, Sidewalks, driveways,
romquees, eta.) will require mepw*te permAsalon.
C -
ON KROLL MAP NO-: PERMIT
I NUMBER
DRESS
?J -7 Y
AR SETBACK
STREET SETBACK
ONE
LOT AREA
S 4
1
700039
13 NO
EXISTING- STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ 1".
FIRE ZONE TYPE OF CONSTRUCTION STEM T IMPROVED
&,;S 0 'TO
SPECULL INSPECTOR REQUIRED OCCUPANCY GROUP
[] YES eolqu I
PLAN CHECKED ISY
REMARKS
Valuation I Fee
Plan Check No ............... ....
BUILDING
HEAT & GAS LINE
I
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL 11
TOTAL AMOUNT DUE
ArrENTION APPLICATION APPROVAL
TMS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
I knowledged in space provided.
INSPECTION DIRECTOR, BIG
DEPARTMENT
CITY OF AT
EDMID"S
]?R 91-110 -70
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