700551.pdf----------
BUILDING DEPARTMENT AppReant FIU
PERMIT APPLICATION Inside Heavy Lines
NAME
MAILING ADDRESS
/
CITY
)N KROLL MAP NO.:
PERMIT
NUMBER
tESS
51
. YES T SITE 13 NO
,RIANCE NUMBER
ADDRESS I .
STREET R/W
CITY ELEPHONE NUMBER EXISTING STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R!W ............ FT. ............ FT. 0
REMARKS
N
C4 ADDRESS
1-30,1 CHECKED BY
CITY ELEPIWNE NUMBER
METER SIZE SERVICE SIZE I CLEARANCE ICHECKED BY
-UT—ATE LICENSE NUMBER CITY LICENSE NUMTER
v-2- 3 Z!72 w iieiow or Attach Four Copies) REMARKS
Legal Description of Property (Bbo
TYPE CONNECTION VERIFIED BY
PERC. TEST PERMIT NUMBER
U
to
REMARKS
0 FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
GAS C] YES [3 NO
RESIDENTIAL LINE PLAN CHECKED BY
NEW 1:1
NON-RESIDENTIAL SIGN
RETAINING REMARKS
DEMOLISH WALL c. 709 of the
El ALTER EXCAVATE PENCE Underground furnaces per se
1:1 OR FILL D ( ......... X .......... Ft.)
EJ REPAIR PRE -MOVE swim
1:1 INSP. POOL u m c 1967
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE Valuation Fee Receipt No.
Plan Check No .....................
Z
BUILDING
PROPOSED UBE,.-
PLUMBING
of
PLOT PLAN (Indicate Building Retbacks, abutting streets) HEAT
PENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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-
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
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
HONATUW(OWNW 0 a DATE �SG77N
S
L7;
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on Private Property ONLY.
Any construction on the public domain (curb@, sidewalks, driviewayop
marquees, etc.) will require separate pern-daslon.
TOTAL AMOUNT DUE
AT"=NTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
ED51ONDS
PR 6-1107
1 —,7 k5- 7 t)
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or bis Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
7�
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