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BUILDING DEPARTMENT I Applicant FIR
PERMIT APPLICATION Inside heavy Lines
or
PERMIT
NUMBER 7 1(
,T SETBACK I REAR YARD I
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'•./ 1 1 [] YES
EXISTING STREET R/W (Qv...FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
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GAS
NEW CI RESIDENTIAL ❑ LINE
NON-RESIDENTIAL ❑ SIGN
ADD RETAINING
DEMOLISH WALL
ALTER ❑ EXCAVATE ❑ FENCE
OR FILL (.......... x.......... Ft.)
PRE -swim
REPAIR ❑ IN Ph10VE POOL
�{� I � — �C,J I Ll YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
❑ YE8
PLAN CHECKED BY
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A`� VJOL4 \ 0 (� V1 I ` ` 10(� (letTm
REMARKS /'O lJ A �Cr
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NUMBER OF STORIES NUMBER OF
DWELLING
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UNITS
NAT E OF WORK TO BE DONE
Valuation Fee Receipt No.
4 4 ✓11 �'y, Vy'_/ i1
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Plan Check No .....................
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BUILDING
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PROPOSED E
PLUMBING
PLOT P AN (Indfcatd Milding setbacks, abuttin streets)
HEAT & GAS LINE
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FENCE
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RETAINING WALL
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SWIMMING POOL
DEMOLITION
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PRE -MOVE INSPECTION
EXCAVATION OR FILL
4 0
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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 laws regu-
lating construction; and In doing the wort authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relatlag to Workmen's Compensation Insurance.
AUTHORIZES
eigned by the Building Official or his Dep-
NOTE: Permi 'mit One Year (Except DE51OLITIONS which
ONLY THE.
WORK NOTED
uty; and fees are paid, and receipt is ac-
Il. be comp to In ninety days; MOVED -IN BUILDINGS ahall be com-
Imowledged in space provided.
pieled In film/aylha.)
{IG ATUR E7 OR NT) DATE SIGNED
INSPECTION
DIRECTOR' GNAT E
DEPARTMENT
/ 1 v +
CITY OF
VOTE: Applicant Subject to Plan Check Fee
EDIIIONDS
DATE
�/
PR d-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc,) will require separate permission.
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