710526.pdfBUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside heavy Linea
NAME (OR NAME OF BUSINESS)
�0A/ US.5A94(kT
MAILING ADDRESS
CITY TELEPIiONE HUMHER
77
U
z
8
i
or
❑ NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
❑
SIGN
ElADD
RETAININGA
D
❑
DEMOLISH
N ALTER
❑
EXAVATE
OROFILL E
❑
FENC.xFt.)
REPAIR
R
PRE -MOVE
.........
SWIM
POOL
INSP.
;UMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
PORTED ON KROLL MAP NO.: I PERMIT
NUMBER 710520
fo
DE YARD SETBACK STREET SETBACK REAR YARD SETB
16 f I I -)- �5;— , I 67/
fI.TE/ � I LOT AREA I VACANT BIT �6O
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
l7 YES ❑ No
❑ YES ❑ NO
THIS SITE IS LOCATED IN THE
REMARKS CI1V Ut- tUIVIUNUb. LOCAL SALES
TAX SHOULD BE CODED 31.04.
L A UJE /N C!I/YF__ V0At`II I
Plan Check No.
l
�A7LRG�
BUILDING
PROPOSED USE
6 �09 V �
PLUMBING
a
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
94
FENCE
iF
SIGN
`
T
1
RETAINING WALL
N
f
I
I
SWIMMING POOL
DEMOLITION
f!I
PRE -MOVE INSPECTION
EXCAVATION 01Y FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state lawn 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
TINS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
BIG TURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
�j
DEPARTMENT
�� 7/
CITY OF
ED,lIONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
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 permission.
Fee
No.
se®
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-
Imowledged in space provided.
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