710476.pdfPOSTED ON KROLL MAP NO.:. PERMIT
WILDING DEPARTMENT NUMBER
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PERMIT APPLICATION Inside Heavy Lines JOB AD ) �
A lE (OR NAME OF BUSINESS).
SIDE YARD SETBACK STREET SETBACK
7I04 0" 1
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HANG ADDRESS
USE ZONE - LOT AREA - VACANT SITE
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CITY TELEPHONE NUMBER
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HEIGHT - BUILDING AREA I VARIANCE NUMBER
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NAME
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PLOT PLAN APPROVED ,
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EXISTING STREET R/W DEFICIENCY THIS PROPERTY
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TELEPHONE NUMBER
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REMARKS
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NAME
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ADDRESS
CHECKED BY
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TELEPHONE NUMBER
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METER SIZE SERVICE -SIZE CLEARANCE
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LICENSE NUMBER
CITY LICENSE NUMBER
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Legal Description of Property (Show Below or Attach Four Copies)-
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NUMBER
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.PERMIT
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REMARKS
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TYPE OF CONSTRUCTION - - STREET IMPROVEDYES
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SrECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
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RESIDENTIAL ❑ LINE
BY- - - -
❑ NEW LD
PLAN CHECKED
THIS SITE IS LOCATED IN THE
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. NON-RESIDENTIAL ❑ SIGN
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DADD RETAINING
❑ DEMOLISH ❑ WAIT'
REMARKS
TAX SHOULD BE CODED 31.04.
❑ ALTER ❑ EXCAVATE FENCE
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OR FILL (.......... x..........
REPAIR ❑ PRE -MOVE swim
❑ POOL
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NUMSBER OF BTORiE9 NUMBER OF
DWELLING
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UNITE
NATURE OF WORK TO BE DONE
Valuation Fee Receipt No.
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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-
lating construction; and In dolog the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
eball be completed In ninety days; MOVED -IN BUILDINGS shall bo com-
pleted In six months.)
VOTE: APP Icant Subject to Plan Check Fee
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 porn lselon.
Plan Check No......
BUILDING
PLUMBING
HEAT d: GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
.96
TOTAL AMOUNT DUE I ( 8, $ (J 6 / Z
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE uty; and fees are paid, and receipt is ac-
NORK NOTED
knowledged in space provided.
INSPECTION DIRECTO 'S SIGN
DEPARTMENT
CITY OF DAT
EDhIONDS 9,9
PR 0-1107
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RECORD OF INSPECTIONS
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Date Passed
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Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace &`Fuel Lines
Final
RECORD OF INSPECTIONS
_
Date Passed
Drainage
Sewer
Parking
Landscaping
Fire'Dept,
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