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BUILDING DEPARTMENT AppllcantFill
PERMIT APPLICATION Illsldo Ileavy Lines
NAME (OR NAME OF BUSINESS)
MA7TNFM/ I_F-I FER
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icription of Property (Show E
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CITY LICENSE N'
or Attach Four Col
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RESIDENTIAL
GAS
LINE
®
NEW
❑ NON-RESIDENTIAL
❑
SIGN
ADD
RETAINING
❑ DEMOLISH
F
WALL
FILL EXCAVATE
ALTER ❑ OR FILL
❑
FENCE
`.x..........Ft.)
❑
REPAIR PRE -MOVE
❑ INSP.
swim
FOOL
YUMBER OF STORIES NUMBER OF
DWELLING
/
/ UNITS
NATURE OF WORK TO BE DONE
<:;A'iV E R j4 6- C O ti
5'7-kA<'T/D�
PERMIT
NUMBER
r--U0 - w
TBACK I STREEE
10420
.CANT SITE 114
YES ❑ NO
,RIANCE NUMBER
EXISTING STREET R/W .... f......FT. DEFICIENCY
��yyTHIS PROPERTY
COMP. PLAN ST. R/W .&.D..FT. ..0... FT. �
REMARKS
"Driveway Slopes not to exceed those indicate
on Standard Drawing #103." w
CER- Oi)C (T76
FIRE
YES ❑ NO
SPECIAL INSPECTOR REQUIRED IOCCUP -NCY gROUP
(] YES )j(NO
,L■ PI¢n Check No .....................
BUILDING
PLUMBING /d
HEAT er GAS LINE
FENCE
SIGN
RETAINING WALL
N
ISWIMMING
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 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
1¢ting 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
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; MOVEDAN BUILDINGS shall be com-
pleted In six months.)
INSPECTION
31GN TU 1E (OWNER OR AGEN ) DATE BIGNEU
DEPARTMENT
g r 7/
CITY OF
EDhIONDB
NOTE: Applicant uLjeet to Plan Check Fee
PR 6-1107
This I'ermlt. coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
Fee
No.
IIa� rl �a4�
APPLICATION APPROVAL ,
This application is not a pennit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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