710228.pdfi
BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (Oft—NK31Z OF
Applicant Fill
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STATE LICEN NUDSBEIt
CITY LICENSE NUMBER
Description of Property (Show Below or Attach Four Ooples)
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6 /6 V.
RESIDENTIAL
❑
LINE
NEW
❑
NON-RESIDENTIAL
❑
SIGN
ADD
❑❑
RETAINING
WALL
DEMOLISH
ALTER
❑
❑
FENCE
Ft.)
ORFILL
(x..........
REPAIR
❑
I RE -MOVE
O
SWIM
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
NO.: PERMIT
NUMBER
.'BACK STREET SETBACK
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710228
REAR YARD SETBA
VACANT SITE
YES �IO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
el,l S
YES
TYPE OF
YES NO
FL64r. M r r. PlER- Qtc
1976
_
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
1
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
formation given to correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state taws rogu- 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 TINS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
plete mouths.)
3 ATUI (OWNER OR AGENT) c DATE SIGN INSPECTION
n� DEPARTMENT
Of CITY OF
EDAILONDS
NOTE: A licant Subject to Plan Check Fee
1'R 8-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
roarquees, etc.) will require separate permission.
Valuation
Fee
OD
No.
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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