700460.pdfBUILDING DEPARTMENT. Applicant Fill
Inside Ileavy Lines
PERMIT APPLICATION
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NAME (VZT ZMWE 81�01_;_0141w_a
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MAHJNG ADDREMS
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PHONE: NUMBER
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NAME)
YARD SI
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)STREET R/W
PLAN ST. R/W
NO.: PERMIT
NUMBER
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TREET SETBA
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'Description of Property (tinow �eiow or Attach If
7- f-2,—
S /=- A / / 90, Uj L_ If 1005t P
19
NEW
RESIDENTIAL
GA13
LINE
NON-RESIDENTIAL
EJ
SIGN
ADD
RETAINING
EJ
Ljj
WALL
DEMOLISH
F]
ALTER
EXCAVATE
FENCE
OR FILL
( .......... x .......... Ft.)
REPAIR
PRE -MOVE
INSP.
swim
POOL
NUMBER 6F
DWELLING
UNITS
ITATURE OF WORK TO BE DONE
& atz)
JeF, 5 '.)VC,
a
FIRE
C] YES
;d
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tnETAINING WALL
N
SWIMMING POOL
DMIOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
a
TOTAL &MOUNT DUE
I hereby acknowledge that I have read this application; that the
In-
formation given Is 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
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
THIS PE101IT
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; BIOVED-114 BUILDINGS shall be com-
pleted In six months.)
INSPECTION
DEPARTMENT
IIGNATURE T) -DATE SIGNED
CITY OF
EDAIONDS
NOTE: Applicant Subject to Plan Chech ree
PR 0-1107
-mids, Permit covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require seporute permission.
CARD SETBACK
-L!r /
0
V 131TE
NO
Z
FCE—NUM13ER
DEFICIENCY THIS PROPERTY
RIFIED
Valuation
Z
Ri I
V
STREET IMPROV]
M_fr_�s No
IOUP
n
Fee I Receipt No.
I
,07 1
100,50
APPLICATION APPROVAL
This application is not a perralt until
eigned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
lmowledged in space provided.
FILE
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