710010.pdfPOST:
BUILDING DEPARTMENT I Applicant Fill —
PERMIT APPLICATION Inside Heavy Lines aos
3l-
SC�/j
or
6
PERMIT
NUMBER
❑ YES
10
IiN
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
FIRE ZONE I TYPE OF
RESIDENTIAL
GAS ❑S❑O
LINE
❑ NEW
I N
PLANCHECKED13Y
ADD
NON-RESIDENTIAL
❑
SIGN
KING REMARKS
RETAINING
❑
DEMOLISH
ALTER
❑
EXCAVATE
ElFENC
xFt.)
..........
REPAIR
INSP
O
WIM
POOL
.
)UMBER OF STORIES
NUMBER OF
DWELLING
I
UNITE
Plan Check No .....................
BUILDING
PLUMBING
streets)
HEAT & OAS LINE
FENCE
SIGN
RETAINING WALL
N
ISWIMMING
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 lawn agu-
ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Stale of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NO E: Permit limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
1 o completed in nety days; MOVED -IN BUILDINGS shall be com-
plete In six mo a.)
110 ATURE ( E OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDhIOND$
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
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 permiselon.
❑ YES ❑ NO
Valuation I Fee
0
Z
No.
r + * 1"MO
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.
I
i
0