700252.pdf00001
BUILDING DEPARTMENT Applicant FIR
PERMIT APPLICATION Inside Ileavy Lines
NAM BUS14PB)
MAILING ADDRESS
Fp 71
C -6—ITY i�PHONE NUMBER
a 49 0//h, - I PIP tq R e4a 4
Q
2113-401-
or
PERMIT
ROLL MAP NO.: NUMBER 700252
�� F_
ETEIACK STREET SETDAU" YARD S_TB
I ;�>_ S I I
LO AREA VACANT SITE
--)I— I 1 0 YES VNO
7S 0 1
EXISTING STREET R/W k!Z.FT. DEFICIENCY THIS PROPERTY
LEPHONE NUMBER COMP. PLAN ST. R/W ... 0 .... FT.
/4 REMARKS
Driveway slopes not to exneflfl thOse
indicated on Standard Drawing #103.
lueac am
�PHONU NUMBER "MROC110C VIL&II/Ace; AWNY I CHECKED BL._
1� .I- J1 fw" HOUSE 4 -ro cuowkr Volvo Be* *%Vel
[B'RESIDENTIAL
1-1
GAS
LINE
Ga/1'
EW
N Ni
E] NON-RESIDENTIAL I
El
SIGN
ADD
ElDEMOLISH
H
RzrAINING
WALL
ElALTER EXCAVATE
1-1 OR FILL
PENCE
( x Ft.)
.......... ..........
REPAIR PRE -MOVE
F INSP.
SWIM
POOL
. IUMBER, IIToI11ES
I NUMBER OF
DWELLING
UNITS
5 F W 15�9_
FIRE ZOV;,�-j TYPE OF CO 1%UU1,1UN bKnzz� Lm"%Vv.�
r_ [] YES NO
SPECIAL INSPECTOR REQUIRED uccuPANuy ORO
(:] YES KNO I T 1 -1-7— 1—
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
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 to 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
kiting 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 PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
lIGVATURE (OWNEI ENT) DATE WIGNED
INSPECTION
DEPARTMENT
CITY OF
ED51ONDS
NOTE: Applicant i1115ject to Plan Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drIvewKys,
marquees, etc.) will require separate permission.
Valuation I Fee
I . 49b
(j &Z -ts�/j
I V 15
APPLICATION APPROVAL
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.
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