710158.pdfr
BUILDING DEPARTMENT
PERMIT APPLICATI®N
I
O
POSTED ON KROLL MAP NO.: PERMIT 7 10158
Applicant Fill NUMBER
Inside Heavy Lines JOB ADDRESS
S 6 ro - / 9 - �_ I. w
SIDE YARD SETBACK STREET SETBACK REAR YARD SE:
e3 ADDRESS
CITY TELEPHONE NUMBEF
F
8 STATE LICENSE NUMBER I CITY LICENSE NUMB
k
Legal Description of Property (Show Below or Attach Four Copies)
NEW
1._.I RESIDENTIAL
LINE
ADD
❑NON-RESIDENTIAL
I
❑
SIGN
❑
DEMOLISH
WAIF RETAINING
EXAVAT❑ E
PE
ALTER
ORCFILL
❑
Ft.)
x..........
REPAIR
❑
INSPn10VE
❑
POOL
(UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
T
I
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 stale laws regu-
lating construction; and In doing the worst 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: E: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
e• i�2sr�s..-� . 12 -2 prwa- 7 /
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, drlvewsys,
marquees, etc.) will require separate permission.
❑ YES ❑ NO
I
PLOT PLAN APPROVED
I '
STREET R/W :
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY I
COMP. PLAN ST. R/W ............FT. ............IT. O
REMARKS
C
Z
I
i
'
CHECKED BY
METER SIZE
SERVICE SIZE CLEARANCE
CHECKED BY
REMARKS
1
'
TYPE CONNECTION
(VERIFIED BY
PERC. TEST
PERMIT NUMBER
a.
I
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION ,:?ROVED
YES No
SPECIAL INSPECTOR REQUIRED
❑ YES ❑ NO
(OCCUPANCY GROUP
PLAN CHECKED BY
REMARKS
.! o n 4 1
1
I ."
Plan Check No .....................
Valuation
Fee
Receipt N7
BUILDING
PLUMBING
f.
I
HEAT & GAS LINE
0
FENCE
SIGN
i
i
RETAINING WALL
I
1
—
SWIMMING POOL
_
i
DEMOLITION
I
�
I;
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUF.
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
by the Building Official or his Dep-
ONLY THEsigned
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
D1 OR'S 40NATURE
DEPARTMENT
�, - ' " --- f, • —
CITY OF
DATE
EDIVIONDS
PR 0-1107
FILE
f ..a
1
.. r
i
r
..
.. _.
1
_....RECORD OF-
INSPECTIONS.:... _....._
...:..
_. .
:,.
-,
D ate Passed
1
Drainage
zf
t
Sewer
t
's
,
Parking:
Landscaping
ks°
\
Dept..
Fire
i
.i
..
i
r
f
..
�,f'
..