710177.pdfBUILDING DEPARTMENT I
PERMIT APPLICATION
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or
Applicant Flu
Inside Heavy Lines
A-,
❑ RESIDENTIAL
❑GAS
LINE
NEW
❑
NON-RESIDENTIAL
EJ
SIGN
ADD
RETAINING
❑
O
DEMOLISH
ALTER
❑
EXCAVATE
❑
PENCE
FILL
OR FILL
`.x..........F1.)
REPAIR
❑
PRE -MOVE
❑
SWIM
POOL
DWELLING
UNITS
L ..
CROLL MAP NO.: PERMIT
/+ NUMBER 710213
CU . I
YES i7 NO
.._.._. _.- --, ..
EXIBTIN6 STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
TYPE CONNECTION (VERIFIED
BY
PERC. TEST I
PERMIT NUMBER
W
REMARKS
m
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES NO
SPECIAL INSPECTOR REQUIRED
❑ YES ❑ NO
(OCCUPANCY GROUP
PLAN CHECKED BY
REMAAXS
e
Plan Check No .....................
Valuation
Fee
Receipt No.
BUILDING
PLUMBING
HEAT h GAS LINE
- / ` b
W�_
I
FENCE
SIGN
RETAINING WALL
N
1 SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read ttt)s application; that the in-
formation given is correct; and that I am tha 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 In ninety days; MOVED -IN BUILDINGS shall be com-
pletrd in six months.)
NOTE: Applicant Subject to Plan Check. Pee
This Permit covers work to be done on private properly 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 0-1107
s
I / t V-0 l k OY4
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.
FILE
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