700304.pdf�1
BUILDING DEPARTMENT Appllcant Fill
PERMIT APPLICATION Inside Heavy Lines
IqAME (OR NAME OF BUSINESS)
,M. kc-ki;P, t5 " -7) *.\ 4VA MICA k
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STATE LICENSE NUMBER CITY I
:Legal Description o operty (Show Below or Atta
S1 1, 1 `11-1
C�__o - %4
RESIDENTIAL GAS
F71 LINE
NEW IL�j
,SIDENTIAL
NON-Rr D SIGN
RETAINING
DEMOLISH WALL
MALTER EXCAVATE PENCE
F OR PILL ( x Ft.)
.......... ..........
F REPAIR PRE -MOVE sWnf
INSP. F POOL
DWELLING
UNITS
t
N
I
I hereby ackno�ledgo 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 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 Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ahall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
NATURE (OWNER OR AGrhNT) DATE SIGNED
M
NOTE: Applicant Stiliject to Plait Check Fee
-This _11ermit coven ivark to be done on private property ONLY.
Any construction on ilia public domain (curbso sidewalkso drIvelvays,
marquees, etc.) will require separate permission.
OBTED ON KROLL MAI' 14U.: PERMIT
I NUMBER
)13 ADDRE88
n -?,R) 9 - -74 Z,)
700304
IDE YARD SETBACK
STREET SETBACK REAR YARD SETH
USE ZONE
LOT AREA
VACANT SITE
�� — S,
E] YES (3 NO
IEIGHT
11 BU[IL5iNG
AREA VARIANCE NUMBER
04
PLOT PLAN AI'FltUVN0
STREET R/W
EXISTING STREET R/W ............ FT.
DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT.
............ I M.
REMARK
CHECKED BY
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
cc
TYPE CONNECTION
VERIFIED BY
V
PERC. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES [j NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
C] YES [] NO
PLAN CHECKED 13Y
REMARKS
wl�,514vc-
Plan Check No ...................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
2, Lit R5
Valuation I Fee
�iiiSft
No.
AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
hTOTAL
THIS PERMIT
This application is not a perrait until
AUTHORIZES
Signed by the Building Official or his x)ep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF DATE f
EDAIONDS
PR 6-1107 0
FILE
I
RECORD OF INSPECTIONS
Date Passed?.!
Foundation
Plumbing
Fram-a
Furnace & Fue! Li.-ws
Final
RECORD OF INSPECTIONS
D3te Passed
Drainage
Sewer
Parking
landscaping
Fire Dept.