710586.pdft
POSTED ON KROLL MAP NO.: PERMITT
BUILDING DEPARTMENT Applicant Fill I
PERMIT APPLICATION Inaldo Heavy Linea JOB ADDRESS� � ar 2 �' � • I r�-`-i
NAME (OR NAME OF BUSINESS) _ ,
omnmcm owmRACK 1 REAR 4A"n SETBACK
W MAI 6 D ESS
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EE
NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
❑
SIGN
ADD
RETAINING
❑
DEMOLISH
EXCAVATE CFITE
FENCEx
ALTER
❑
❑
Ft.)
..........
REPAIR
O
Pwim
RE -MOVE P.
El
POOL
DWELLING
UNITS
WORK
e� //T!!O/�B/EE DONE
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• h _ Z C-®. el"
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 doing 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 Innurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drlvewa)s,
marquees, etc.) win require separate permission.
( I Lyr
USE ZONE I LOT AREA VACANT SITE 7.
(❑YES ❑No zz3
HEIGHT I BUILDING AREA I VARIANCE NUMBER p,
PLOT PLAN APPROVED 4
STREET R/W I(
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT. `.
REMARKS
W
C
W i
CHECKED BY
i
METER SIZE I SERVICE SIZE I CLEARANCE I CHECKED BY �.
{{{W ?
REMARKS E
QIA
TYPE CONNECTION VERIFIED BY r t.
PERC. TEST I PERMIT NUMBER ly
W I,
REMARKS ( m
FIRE Z I TYPE OF CONSTRUCTION I STREET IMPROVED
❑ YES ❑ NO
8 DIAL INSPE�CpTOR REQUIRED (OCCUPANCY GROUP
)1 YES NO C
PLAN CHECKED BY
THIS S!TE IS !_CC.1T _7 IN THE I
I d t1=s
REMARKS TAX SHOULD GE CODED 31.04.
ALL MAKle (Pm UM C 1976
1
Valuation Fee Receipt No. �
Plan Check No .....................
BUILDING i
_ I
PLUMBING
HEAT & GAS LINE !
i
FENCE
SIGN
}
RETAINING WALL
SWIMMING POOL
— I
DEMOLITION
PRE -MOVE INSPECTION I�
4
EXCAVATION OR FILL
f
TOTAL AMOUNT DUE
ATTENTION APPLICATION APPROVAL i
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLTHE
WORIL NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
i
INSPECTION DIRECT 'S SIGNATURE
DEPARTMENT i
CITY OF DAME
EDMONDS i
PR 6-1107
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