710156.pdfi
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IPOSTED
ON KROLL MAP Nov:
PERMITNUMBER
I 0 156
BUILDING
DEPARTMENT
Applicant Fill
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PERFAIT
APPLICATION
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JOB ADDRESS
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NAM (OR NAME OF 13 INE80)
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SETBACK
STREET SETBACK
REAR YARD BETM
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SIDE YARD
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riptlon or Property (8b w Below or
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A
RESIDENTIAL
❑
GAS
LINE
NEW
NON-RESIDENTIAL
❑
SIGN
ADD
❑
RETAINING
El
DEMOLISH
ALTER
EXCAVATE
❑
FEN CE
❑
FILL
OR FILL
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REPAIR
PRE -MOVE
INSP.
swim
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
'
NO
STREET li/IV .�
EXISTINGT.
COMP. PLAN ET R/W ((/...l.�.IT. DEFICIENCYp �THIS PROPERTY
ST......FT.
r
I� I r NJ 3
9 YES ❑ NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY OUP
❑ YES
Ptan Check No ...................
PROPOSED USE
BUILDING
a PLOT PLAN (Indlcato Building setbacks, abutting streets) PLUMBING
N
„0� � � � HEAT & GAS LINE
+S\ 0. PENCE
SIGN
v RV..rAINING WALL
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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 am the owner, or the duly author.
Ized agent of the owner. I agree to comply with city and state laws regu- 1 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 DE31OLITIONS which IVORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS stall be com.
pleted In six months.)
81GN - RE (OWNEiI"'bR' AGENT) DATE SIGNED INSPECTION
DEPARTMENT
CITY OF
F.DMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (turbo, sidewalks, driveways,
marquees, etc.) will require separate permission.
t:�;7 51 sW,
Fee
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APPLICATION APPROVAL
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.
DIRECT�R'S 8I"AT�jRE
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