700421.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
Berk
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NAME
ADDRESS
CITY
-YE-LEPIV
NAME
ADDRESS
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CITY
TELEPH
STATE LICENSE NUMBER
CITY L11
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Legal Description of Property (Show Below or Attach
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NEW
IN RESIDENTIAL
I
-1
F
GAS
LINE
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NON-RESIDENTIAL
SIG14
AVU
RETAINING
nDEMOLISH
WALL
EXCAVATE
FENCE
ALTER
OR FULL
( x Ft.)
REPAIR
PRE -MOVE
INSP.
.......... . ........
SWIM
POOL
_�.NUMBER
OF
DIVIELLING
N T.
PROPOSED USE
Ife _y /
-PLOT PLAN (InC
t
N
I
I hereby acknowledge that I have read this application; that the In-
formation given In 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.
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of WaAhIngton
relating to WorkalOn's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
)N KROLL MAP NO.: PERMIT
NUMBER 700421
.I.!Q W I
01
LESS
ID SETBACK STREET
REAR YARL) bhiELSACK
1h 1--i a257
fe6w 47'
STREET R/W
EXISTING STREET R
COUP. PLAN ST. R
indicated on Standard Drawing #103.
1�040
0 YES
REMARKS
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
LP e�_ 9� I �_ 9--17a 1,
NOTE: Applicant Subicct to Platt Chcck- Fce
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees. etc.) will require separate permission.
TOTAL AbIOUNT DUE
ATTE NTION
THIS PERMIT
AUTIIOIUZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
ED51ONDS
PR 6-1107
)x
By
[3 NO
D
PROPERTY
YES NO
Fee
1 0 1 01 VAW 9
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-
knowledged in space provided.
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