710223.pdf' BUILDING DEPARTMENT
/PERMIT APPLICATION
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PED ON KROLL MAP NO.: PERMIT ����
/ NUMBER
ADDRESS Vb
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YARD SETBACK STREET SETBACK REAR YARD SETBACK
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ZONE LOT AREA - VACANT SITE
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UHT BUILDING AREA VARIANCE NUMBER
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............ IV.
REMARKS
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INECTION I VERIFIED BY
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RESIDENTIAL
F LINE GAS [I YES
CHECKED BY
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❑ NON-RESIDENTIAL ❑
BIGN
❑ ADD ❑ DEMOLISHRETAINING REMARKS Q 3
El WALL og-tGrIU41.. �C'�R-►i>I� % 1��3`I ❑ ALTER EXCAVATE FENCE L� �/� '` 1 , Q'•�
OR FILL S..........x..........Fl.) � Es �,c P .e c , � VZ V � Q '1 \ 1 6
ElREPAIR IND'P•hIOVE O SWIM �.'1�•
NUMB OF STORIES I NUMBER OF
DWELLING /
UNITS
NATURE OnF� 1WORK,TTOe�BE D�1NE Valuation Fee Receipt No.
'✓ e w �t J 1�• tic — Plan Check No..
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[[.O BUILDING
Oy PROPOSED USE
a PLUMBING
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PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT & GAS LINE
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FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In- (Q
formation given Is correct; and that I tan the owner, or the duly author-
Ized agent of the owner. I agree to comply with city end stale laws regu• ATTENTION APPLICATION APPROVAL
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 This application Is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES aigned by the Building Official or his Dep-
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt Is ac-
shall be compl led In ninety days; MOVED -IN BUILDINGS shall be com- knowledged in space provided.
pleted In elx onths.)
Si AT �{ WNEI t O T) DATE SIGN Ell INSPECTION DIREC ' It's 8116 T E
DEPARTMENT
/ CITY OF 2
ED51ONDS DAT
NOTE: Applicant Sitbject to Plan Check Fee
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This Permit covers work to bo dune on private property ONLY.
Any eoattructlon on the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate permission•
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