710502.pdfPOSTED ON KROLL MAP
NO.: PERMIT
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BUILDING DEPARTMENT
Applicant Fill
I NUMBER
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PERMIT APPLICATION
Inside Ileavy Lines
JOB ADDRESS
NAME (OR NAME OF BUSINESS)
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SIDE YARD SETBACK
STREET BF.T➢AUl' I
It&AR YARU_ 8 T➢ACR
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MAILING ADDRESS
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BITE
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USE ZONE
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LOT AlEA
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VACANT
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14
CITY
TELEPHONE NUM 'R
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❑ YES
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2
HEIGHT I
BUILDING AREA I
VARIANCE VAIBER
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NAME
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PLOT PLAN APPROVED
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ADDRESS
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STREET R/W
EXISTING STREET R/W
............FT. DEFICIENCY THIS PROPERTY
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CITY
TELEPHONE NUMBER
COMP. PLAN ST. R/W
............FT.
............F'r.
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REMARKS
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NEW
7ADD
EJALTER
ElREPAIR
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TYPE
TYPE OF
STREET IMPROVED
❑ YES ❑ NO
GAS ❑ YES ❑ NO
RESIDENTIAL ❑ LINE PLAN CHECKED BY
NON-RESIDENTIAL ❑ SIGN
ElWATLL REMARKS
DEMOLISH THIS SITE IS LOCATED IN 'tl
EXCAVATE FENCE CITY OF cnesr,,,,,.., LOCAL
OR FILL (..........x..........Ft.)ti 1: S
PRE -MOVE swim TAX SHOULD BE CODED 31.04.
INSP. 1:1POOL
DWELLING
UNITS
Plan Check No .....................
` BUILDING
UBE
PLUMBING
N (Indicate Building setbacks, abutting streets) HEAT & GAS LINE
FENCE
SIGN
tRETAINING 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 -
tied agent of the owner. I agree to comply with city and state laws regu.
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
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WOBK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
31GNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
7
DEPARTMENT
CITY OF
EDhiONDB
NOTE: Applicant Subject tfi tan Cficck Fee
PR 0-1107
Permit coven work to be done on private property ONLY.
construction on the public domain (curbs, sidewalks, driveways,
h; marquees, etc.) will require separate Permission.
Valuation I Fee I Receipt No.
OU
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.
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