710048.pdfI
BUILDING DEPARTMENT
PERMIT APPLICATION
NAM ( )
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6 pDDREBS
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POSTED -ON KROLL MAP NO.: PERMIT
Applicant Fill NUMBER
Inside Heavy Lines JOB ADDRESS
A& SIDE YARD SETBACK I STREET SETBACK
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NAME
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ADDRESS
F
CITY
TELEPHONE NUMBER
NAME
C
ADDRESS
CITY
TELEPHONE NUMBER
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STATE LICENSE NUMBER
I CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
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❑
GAS
LINE
❑RESIDENTIAL
NEW
❑
NON-RESIDENTIAL
BION
❑ ADD
DEMOLISH
VALLNINC
ALTER
El
EXAVA
ORCFILLTE El<ENC
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REPAIR
❑
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PREP.
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swim
NUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
T
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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 elate 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.)
NOTE: Applicant Subject to Plan Check Fee
YES
710048
NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
CHECKED BY
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SIZE I SERVICE SIZE I CLEARANCE I CHECKED BY
tKS
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CONNECTION I VERIFIED BY
TEST I PERMIT NUMBER �•
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IKS
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TYPE OF CONSTRU ION j STREET IMPROVED ."
/ �/`/' I O YES ❑ NO
YES [' Di0
PLAN CHECKED BY
S(Z-Gi cy _. 6-w s-r gz� CAppee) hT
Plan Check No .....................
Valuation
Fee
Recelpt No.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
cx
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
Q. O O
5-vs
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
INSPECTION
DEPARTMENT
CITY OF
ED31ONDS
PR 6-1101
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his Dep-
ut and fees are aid, and receipt Is ac-
knowledged in space provided.
DIRECTQFj,'8 8iO U 1:
-
DATE
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. I FILE
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