710106.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
MAILING AD REBB
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Applicant Fill
Inside Heavy Lines
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NEW
KA RESIDENTIAL
ElLINE
GAS
In
NON-RESIDENTIAL
❑
ADD
SIGN
NING
M
WALL
❑
DEMOLISH
FENCE
ALTER
❑
ORFILL
❑
❑ REPAIR
❑
FRE-MOVE
IN8P.
ED
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SWIM
POOL
(UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
MAP NO.: I NUM IT 710106
❑ YES [] NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
1 MARES k
iQ V
Y11Y901
FIRE ZONE
YES NO
Plan Check No .....................
BUILDING
y PROPOSE USE PLUMBING
U
aPLOT PLAN (Indicate Building setbacks, abutting streets) HEAT & GAB LINE
07
FENCE
SIGN
RETAINING WALL
N
SWIMMING 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 nm 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. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORE NOTED
shall a completed In ninety days; MOVED -IN BUILDINGS shall be com-
pl• a In six months.)
I URE (OWNER Olt �l..ENT) 1,- DAT ' SIGN `D INSPECTION
7 J DEPARTMENT
CITY OF
EDi1IOND8
N : Applic it Subject to Plats Check Fee
PR 0-1107
This Permit covers work to be done on private prol,erty ONLY.
Any construction on the public domaln (curbs, sidewalks, drlvewsys,
marquees, etc.) will require separate permission.
Valuation
YES ❑ NO
Fee
APPLICATION APPROVAL
I
I
1 ,
No.
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
,
4-
FILE