710146.pdfPOSTED ON KROLL MAP NO.: PERMIT
FNAME
G DEPARTMENT Applicant Fill NUMBER
APPLICATIONInside Heavy Lines JUB ADDREdB
7 / (l ;1O 3.,�SIDE YAI(D 8ETBACK STREET SETBACK
R S % dams.(DREdtI ,y^'h—,Lt„rd I g. ^�i)?f>.(�U •Sl o LOT AREA
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NEW
RESIDENTIAL
F-1
GAS
LINE
ADD
®
NON-RESIDENTIAL
❑
SIGN
RETAINING
❑
DEMOLISH
Q
LEl
ALTER
❑
EXCAVATE
❑
FF.NCE
Ft.)
.x..........
REPAIR
❑
INSPbIOVE
SWIM
POOL
DWELLING
UNITS
1
N
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 work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed to ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
-7 So
EXISTING STREET R/W
COMP. PLAN ST. R/W
VACANT 81TE
0 YES 114NO S
VARIANCE ,(LUMBER
THIS PROPERTY
privewAy slopes not to exceed those indicated
I^ I0 YES El NO
SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP I
❑ YES Y NO
Plan Check No .....................
Valuation
Fee
Receipt No.
BUILDING
Z �(A M
Z JJ
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY TILE
ut and fees are aid, and receipt is ac-
OTT
knowledged in space provided.
INSPECTION
DiRECTI'8 SI A URE
DEPARTMENT
CITY OF
DATE
i
ED51ONDS
PR d-1107
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