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rBU1LDING DEPARTMENT
f
PERMIT APPLICATIQPI
NAME
Appueane Fui
Inside Hoavy Llnee
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ADDRESS
CITY I TELEP110NE NUMBER
or
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NO.: � PERMIT
NVMBEn
.a .. � n -
EXIaTIN6 STREET R/W ..._.......FT.
COMP. PLAN BT. R/W ............FT.
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0
NO
DEFIOIENCY THIS PROPERTY
❑YE9 ❑NO
SPECIAL INSPECTOR REgUIF.tED (OCCUPANOY GROUP
OA8 ❑YES ❑ NO
NEW RESIDENTIAL O LINE PLAN CDECKED BY
NON-RESIDENTIAL ❑ BION
ADD - O W L.I. NINE REMARKS
DEMOLISH
ALTER EXCAVATE FENCE
OR FILL � G._....at._.._...Ft.) -
REPAIR ❑ INSPMO� � POOL
iUMBER OF STORIES NUMBER.OF
DWELLING
UNITS
9ATUR19 OF WORK TO BE DONE � Valuatloh - Fee � Receipt D
��W �y�iVAeLC Plea Check No...._....__.._...
BUILDING
PROP08ED U8E ,.
PLUMBING
PLOT PLAN (Indicate Butlding setbacks, nbultln6 streets) ,HEAT d: 6A9 LINE /�� QPt�' - r' OO
i r
FENCE
SIGN
RETAINING WALL
N
ISWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR I"ILL
I heroby ackbowledge that I have rend this aDPllcatlon; that Ota In-
tormatlan given 1s wrrect; and that I am the owber, or the duly nuthor-
lxed agent of the owner. I agree to comD1Y with city and elate levee rogu-
lating wastructlob; and W doing the work aulhorizad lhtroby, ao Dereon
will be employed In violation of We Lnbor Coda of tW State of Wsehlagton
rolating to Workmen's ComDeneatloa Ineurmce.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed 1a ninety days; MOVED -IN DOILDINOB shall be com-
Dlattd Ia e1x mobthe.)
NOTE: Applicant SuGiect to Plan Check Fee
Thle Permit coven
work to
be done
on prlvale property ONLY.
Aay eoaetructlon on
the publle
domain
(curbs, eldewdke, driveways,
marquees,
etc.) wW
regmre
eeperate pamleelon.
ATTENTION
TFiIB PERMIT
A.UTIIOBIZEB
ONLY TID".
WORN NOTED
INSPECTION
DEPARTMENT
OITY OF
EDIISOND$
PR 6-1107
7, o o ���5'i � � �
APPLICATION APPROVAI.
This application is not a permit until � '•
signed by the Butlding Official or hta Dep- I ,
uty; and fees are paid, and receipt 1a ac-
Itnowladged >n space provided. 1
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