710037.pdf�., BUILDING DEPARTMENT AppllcantFlll
PERMIT
APPLICATION
Inside Heavy Lines
NAME
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AILING
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TELEPHONE NUMBER
NAME
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ADDRESS
CITY
I TELEPHONE NUMBER
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CED ON ItROLL MAP NO.: PERMIT 003�
o NUMBER 71
ADDRESS
(J
5fi q 3.5- / `) c1
BIDE YARD SETBACK
STREET SETBACK
REAR YARD SF.TBACH
t 1-�, J I�
i diM.l I
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NE
LOT AREA
VACANT SITE
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❑ YES ❑ NO
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FiEI HT
BUILDING AREA
VARIANCE NUMBER
PLOT PLAN APPROVED
oa aaaar.a a./.r
EXISTING STREET R/W ��^.....FT. DEFICIENCY, THIS PROPERTY
COMP. PLAN ST. R/W -Ii. ,.[-FT. ,,,...FT. t7
REMARKS
Drivewav slopes not to exceed those indicated p�W
0
on Standard Drawing #103. w
CHECK= BY
METER I/1ZE I SERVICE SIZE I CLEARANCE I CHECK BY !07
PERC. TEST
PERMIT N BIBER
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REMARKS
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FIRE Z TYPE OF CO UCTjON �— 6 SET IMPROVED
tipJl�lr/Y
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N YES ❑ NO
SPE.IAL INSPECTOR REQUIRED
OCCUPASICY G OUP
GAB
Land RESIDENTIAL El
❑ YES NO I J7— I
NEW LINE
PLAN CHECKED BY
❑ NON-RESIDENTIAL 1 1
`J SIGN
F�
1
❑ ADD RETAINING
WALL
REMARKS
!
DEMOLISH
ElALTER EXCAVATE FENCE
OR FILL El
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(.......... x.......... Ft.)
PRE -MOVE SWIM
ElREPAIR ❑ INSP. POOL
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i
NUMBER OF BTOl(lE9
NUMBER OF
DWELLING /
'
UNITS
NATURE! OF WORK TO BE DONE
Valuation Fee Receipt No.
Plan Check No .....................
S,
Pt�9p USE
BUILDING(]J��
PLUMBING
a
PLOT PL N (Indicate Building setbacks, abutting streets)
HEAT rk GAS LINE
FENCE
SIGN
RETAINING WALL
N
i
SWIMMING POOL
IDEMOLITION
' '� i+ •1 /'
PRE -MOVE INSPECTION
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EXCAVATION OR FILL
I hereby acknowledge that I have read this appllcatloa; that the In.
TOTAL AMOUNT DUE
''�7
73 i
6773
formation given Is correct; and that I am. the owner, or t'is duly author-
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tzed agent of the owner. I agree to comply with city and :Mato laws regu•
ATTENTION
APPL"CATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Stal. of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One gear (Except DE1101,111ONS which
ONLY THE
WORM NOTED
uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS 311111 be com-
knowledged in space provided.
pleted In six months.)
SIGNATURE (01 ER O! AGENT) DATE SIGNED
INSPECTION
DIRECTOR' SIGN U4-c
- /
DEPARTMENT
CITY OF
`
EDAIQND,S
DATE
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 permission.
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