700485.pdf2
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)N KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fill NUMBER
1 700485 1
Inside Ileavy Lines JOB ADDRESS
PERMIT APPLICAI I I Q;�(Nj
NEW
F1 RESIDENTIAL
1 I
n
GAS
LINE
1:1
NON-RESIDENTIAL
_1
r
SIGN
0 ADD
F1DEMOLISH
RETAINING
WALL
ElALTPR'
EXCAVATE
FENCE
Ft.)
OR FILL
( .......... x ..........
REPAIR
El
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
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
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compenflationt 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.)
gel 7
NOTE: Applicant Subject to Plats Check Fee
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.
EXISTING STREET R/W ............ FT
COUP. PLAN ST. R/W ............ FT
11
FIRE
0 YES [] NO
Plan Check No ..............
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
[3 YES C3 NO
DEFICIENCY THIS PROPERTY
[] YES [] No
Valuation I Fee
I"
TOTAL AMOUNT DUE 2
ATTENTION APPLICATION APPROVAL
No.
TIUS PERBUT This application Is not a permit until
AUTIIOIUZE8 signed by Me Building Official or Itis Dep-
ONLY THE
WORK NOTED uty; and f Sea are paid, and receipt is ac-
I knowlcdged in space provided.
INSPECTION DIRECTOR.8 G AT
DEPARTMENT
CITY OF
DATE
EDIVIONDS
PR 6.1107
FILE
RECORU U� m
Date Passed
Drainage
Sewer
Parking
Landscaping
Fire Dept.
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