710078.pdf,ti BUILDING DEPARTMENT
PERMIT APPLICATION
NAME ( t
4t �,c
AI 3 3 REBB 516
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U
Applicant Fill
Inside Heavy Lines
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ce)
et ADDRESS
9 2 6 _ G�
CITY TELEPHONE NUMBER
or
r
3TED ON KROLL MAP NO.: PERMIT 1 l 00j�8
ADDRESS a,
L��± NUMBERR/ �' `
BIDE YARD SETBACKI
STREET BETBACK (REAR
YARD, SETBACK
USE ZONE
9
I LOT AREA
VACANT SITE
❑ YES ❑ NO
HEIGHT
I BUILDING AREA
I VARIANCE NUMBER
PLOT PLAN APPROVED
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
ZONE I TYPE OF
PIV4
❑ YES ❑ NO
EJ RESIDENTIAL ❑ GAB ❑ YES ❑ NO
NEW LINE PLAN CHECKED BY
NON-RESIDENTIAL SIGN
ADD ❑ DEMOLISH RETAINING REMARKS
y' ` ��f fir- i /�
WALL Gic N ?eIv Sec. 12,I"5t116
❑ ALTER ❑ EXCAVATE FENCE J
OR FILL (.......... x.......... Ft.) Max• i't G`KI�� �- M(� 7+
REPAIR ❑ IN PE-. O POOL
:1
;UMBER OF STORIES NUMBER OF ' r �[7�.�t
DWELLING
UNITS ge-RM ITr� Dt..t_.i.41 S p// nW PM l
MATURE OF WORK TO BWONE -`� e,�F '4 I Valuation I Fee L
CD l Gj rI/l. iy 1/(�/(.,:r/(�ee(/
rlan Check No .....................
G
(ZO.
!J
BUILDING
q PROPOSED USE
a�
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
•s
FENCE
SIGN
tRETAINING
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 laws regu-
ATTENTION
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
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTIIORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In el onths.)
SIGNATUf (OWNER OR AGENT) DATES NE D
INSPECTION
DEPARTMENT
7i
CITY OF
ED51ONDS
NOTE: Applicant Subicct to Plan CGcck Fce
PR a-IIOT
This Permit corers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
I
No.
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Off lcial or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged In space provided.
FILE
I