710173.pdfr_.
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BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OiF-1i+41i i1Lii18Hf r ��
i
Appucallt FILL
Inside Heavy Lines
Ab7)1tE88
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TELEPIiONE NUMBER
Z A4 s 3 6
E
W 1 'ADDRESS
Ig yo 27
Z CITY
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regal Description of Property (Show Belo%
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PERMIT
NUMBER
FeW00"KAF
O YES
D SETBACK
rt7 i
TE �+
[] NC
NUMBER
STREET R/W
EXISTING STREET R/W ............ TT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............Fi.'. ............FT.
REMARKS
0
W
t7
W
CHECKED SY
METER SIZE I SERVICE SIZE
I CLEARANCE
I CHECKED BY
WCd
H
REMARKS
CD
r
TYPE CONNECTION
(VERIFIED BY
PERC. TEST
PERMIT NUMBER
Q.
I
REMARKS
OF CONSTRUCTION STREET IMPROVED
I YES ❑ NO
GAS RESIDENTIAL O GAS I
INS ❑PLAN CHECKEDYES ❑BYO
NEW
NON-RESIDENTIAL SIGN
❑ ADD RETAINING REMARKS
® DEMOLISH WALL IP� �C SLC
ALTER EXCAVATE FENCE
OR FILL (.......... x.......... Ft.) T
❑ REPAIR ❑ INBPniOVE ❑ SWIMPOOL I I W t t 5ce
)U➢SBER OF STORIES I NUMBER OF1Q'j`�-
DWELLING
UNITS
iATURE OF WORK TO BE DONE Valuation Fee Rccelnl No.
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
TRETAINING WALL
N
ISWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the in.
formation given In correct; and that I am the owner, or the duly author-
1 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
(VOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
/ SI NA RE (ONNE OR NT) DATE SIGNED INSPECTION
DEPARTMENT
71 CITY OF
ED51ONDS
NOTE pplica t Subject to Plan Check Pee
PR 8-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drfvewgs,
nmrqueen, etc.) will require separate permission.
at 0 L&o/7
APPLICATION APPROVAL
This application is not a permit until
eigned by the I3tillding Official or his Dep-
uty; and fees are paid, and receipt is ac-
lmowledged in space provided.
—JUG
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-RECORD OF INSPECTIONS'...
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Date Passed
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tio ':Foundation
a'
i Plumbing (Partial)
(Rough)
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Fuel
& Furnace el Lines �f = Z•
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Final /
RECORD LbF..IN5FECTIOh!S µ
Date Passed
Drainage
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