710108.pdfBUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION
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❑ NEW
RESIDENTIAL
LINE
❑
NON-RESIDENTIAL
❑
SIGN
ADD
❑RETAINING
WALL
ALTER
❑
DEMOLISH
EXCAVATE
ORFILL
❑
FENCE
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..........
REPAIR
❑
INSP.
❑
WIM
POOL
iUMBER ON` STORIES
NUMBER OF
DWELLING
UNITS
MAP NO.: PERMIT ZTMBER
TER 710108
0 YES C3 NO
-- --- - - . --
EXISTING STREET R/W ............FT. DEFICIEN:::::CY THIS PROPERT
COMP. PLAN ST. n/w ............FT. ............FT.
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REMARKS
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YES NO
OF
Plan Check No .....................
BUILDING
PLUMBING I
HEAT d: GAS LINE
FENCE
SIGN
RETAINING WALL
N
ISWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read thin 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 dolog the work authorized thereby, no person
will be employed In violation of the Labor Code of the Stale of Washington
relating to Workmen's Compensation Insurance.
Nrt'A
Permit Limit �Dne Yenr (Except DEMOLITIONS which
ancompleted In ninety days; MOVED -IN BOILDINOS shall be com-
p six months.)
it //II R cGFINT/ - I DATJW
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NOTE: AppliWnt Siibeclt to Plan Check Fee
This Permit covers work to be done on prlvnte property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
ED51ONDS
PR d-1107
BY
0 YES ❑ NO
Fee
No.
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APPLICATION APPROVAL
This application is not a permit untll
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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