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POSTED ON KROLL MAP NO.: PERMIT 710243
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AUILDING DEPARTMENT APPllean2 Fill /� n 7/f� I
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-- PERMIT APPLICATI®H Inside Heavy Lines JOB ADDRESS I/ N
NAME (O
� SID1: YARD SETBACK ST EECT SETBACK REAR YARD SETBACK
DSAI - G AD ESB _ r (�� I p� a ( lit -I •I i .li].�.
E 00 q1 148141, C, W USE ' N +� LOT AREA VACANT SITE Pi'
{s CiTVY(+/ �_))'"''' �J� LEFHONE NUMBERIIEIO d` I BUILDING AREA I ❑VARIANCE UMBER
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No NAME //''�� ,
F ) •��.. , PLOT PLAN APPROVED
Uhyyl ADDREBB % �/ 'j�F}/� _
U _8 4 / / �'�I rltf Y, %G•1 / / STREET EXISTING STREET
t CITY TELEPHONE NUMBER R COMP. LAN ST. R FT. DEFICIENCY THIS PROPERTY
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NAME J � , Iw ............
IS ADDr1DRE88 Z CHECKED BY
CITY A .ELEPHONE NUMBER
O nh.LI s I717Z¢ -490OQA1:1, METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENSE NUMBERI C1T LICENSE NUMBER I I I al
REMARKS g
Legal Description of Property (Show Below or Attach Four Copies)
]( / .2 / � . [] r.4— gc.2 —Y' LAv /0-A TYPE CONNECTION VERIFIED BY
/0d-II a ae- L. l I7 O C PERC. TEST I PERMIT NUMBER
94
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O REMARKS
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00 FIRE Z02 i-- I TYPE OF CON UCT N I STREET IMPROVED I '�
�" 11'�!/1/�. YES ❑ NO '
GAS
❑ LINE
❑ YES NO
FI NEW
PLANCHECK D BY
LESIDENTIAL
ON -RESIDENTIAL SIGN
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�"-ADD RETAINING
REMARKS
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❑
DEMOLISH
❑ ALTER EXCAVATE FENCE
OR FILL (.......... x.......... Ft.)
-
REPAIR ❑ INS PRE -MOVE SWIM
Q P. POOL
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NUMBER OF BTOlIlEB NUMBER OF
DWELLING
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UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee
Recelpt No.
Plan Check No .....................
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BUILDING
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PROPOSED LPE
PLUMBING
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PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT d: GAS LINE
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FENCE
SIGN
-
RETAINING WALL
N
ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AL[OUNT DUE
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I hereby acknowledgo that I have read this application; that the In-
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formation given is correct; and that I am the owner, or the duly author-
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lzed agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
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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
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be corn-
limowiedged in space provided.
pleled In six months.)
SIGNATURE (OWNER OR AGENT) DATE S16N
INSPECTION
DIRECTOR'$ BIGNATU E
DEPARTMENT
CITY OF
G
EDIIIOND5
DATE
VOTE: Applicant Subject to Plan Check Fee
Plt 0-1107
This Permit covers work to be done on prlvnte property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.
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