710210.pdf,.9
i
BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fiil
Inside Ileavy Lined
/
'(
M iLINADDRESS
tl
CITY + t
TELEPHONE NUMBER
__
!I '., J
NAME
�y
yUj
ADDRESS
a7
C
CITY
'TELEPHONE NUMBER
I F-0• 14
y2,3--02T��r.:
or
RESIDENTIAL
❑
GAS
LINE
I ICI NEW
❑ ADD
❑
NON-RESIDENTIAL
r I
SIGN
KING
❑
DEMOLISH
❑
WALLEl
PENCEx
ALTER
1-1
OROFILLTE
Ft.)
❑ REPAIR
❑
INSPPRE-MOVE
.
..........
SWIM
POOL
MISER OF STORIES
NUMBER OF
DWELLING
UNITS
JATU�R+EE UP WORK TO BE DONE
MAP NO.: ,
PERMIT
NUMBER I
tl
VACANT SITE
❑ YES E3 NO
VARIANCE NUMBER
F.XISTINO STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
YES NO
Pian Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In.
tormntlon Riven 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- ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employe) In violation o[ the Labor Code of the State of Washington T1H8 PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed !n ninety days; a[OVL•'U-SN BUILDINGS shall ba cam-
pleted In six months.)
11GNATURE (OWN ENT) DATE SIGNED INSPECTION
DEPARTMENT
/ CITY OF
ED5IONDS
NOTE: Applicant Subject to Plan Check Pee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
YES 0 NO
Valuation I Fee
R0
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
s
4
3
6
r
9