700476.pdfr
_KROLL MAP NO.:
POSTED ON PERMIT
BUILDING DEPARTMENT Applicant F111 I NUMBER 7004-116
N Inside Ifeavy Lines JOB ADDRESS
PERMIT APPLICATIO
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TELEPHONE: NUMBER
LICENSE NUMBER
CITY LICENSE NUMBER
D�xrrffitlon of Proncrtv (Show Below or Attach Four CoPles)
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RETAINING
WALL
ElALTER
DEMOLISH
EXCAVATE
PENCE
El
OR FILL
( x Fit.)
E] REPAIR
1:1
PRE -MOVE
INSP.
El
.......... ..........
SWIM
POOL
;UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
qATURE OF WORK TO BE DONE
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VAU&NTSITA
YES t6 0
]EIGHT
BUILDING AREA
VARIANCE NUMBER
['LOT PLAN PPROVED
"TREET R/W
j
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
DEFICIENCY THIS PROPERTY
............ FT.
REMARKS
CHECKED BY
METER SIZE I SERVICE SIZE I CLEARANCE
CHECKED BY
REMARKS
TYP$� ZONNECTION
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I VERIFIED
I
BY
PEICC. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE I TYPE OF CONSTRUCTION
113TREET IMPROVE2
::QE I V_ " I Cj YES [:1 NO
SPECIAL--MBPECTOlt REQUIRED OCCUPANCY GROUP
(3 YES
PLAN CHECK BY
REMARKS
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Plan Check No .....................
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BUILDING
�_R_OPOSED USE
PLUMBING
T3c,.L i- to o," c
HEAT & GAS LINE
FENCE
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 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-
ATTENTION
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
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.)
3IGNATURE (OWNER OR AGENT) DATE SIGNED—
INSPECTION
"ZA
DEPARTMENT
CITY OF
ED51ONDS
NOTE: Applicant Sitbject to Plan Chech Fee
ra 6-1101
This Permit covers work to be done on private prolmrty ONLY.
Any construction on the public domain (curbs. sidewalks, driveways,
marquees, etc.) will require separate pernihision.
Valuation I Fee I Recelpt No.
no
1 6. 0 0 1�571_3 eb
APPLICATION APPROVAL
This application is not a �errnit until
eigned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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FILE
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