690398.pdfI
POSTED ON KROLL MAP N
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
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C)L
E OR NAME OF BUSINNUU)
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E lo
SIDE
YARD SETBACIC STREET SETBACK
.141
21
A � YARD SETS
1P 4r
MAILING ADDRESS
U
[A
0 7j e) 7.q
USE ZONE
HEIGHT
LOT ARBIL
ARE..
VACANT SITE
YES 13 NO
VARIANCE NUMBE
CITY
TELEPHONE NUMBER
qV3— 9va9
41 ADDRESS
STREET R/W OPERTY
1-71 a 60 EXISTING STREET R/W ........ ... FT- DEFICIENCY THIS PR
TELEPHONE NUMBER
3L, XT. ........ ...
COUP. PLAN ST. R/W ...........
Z RPMARICH
C11
0 ADDRESS
TELEPHONE NUMBER
el e,
or
D�RESIDENTIAL
GAS
LINE
NEW
ADD
1 1:1 NON-RESIDENTIAL
SIGN
RETAINING
DEMOLISH
WALL
ALTER
EXCAVATE
OR FILL
FENCE
( X Ft.)
.......... .........
REPAIR
PRE -MOVE
INSP.
SW`IM
POOL
NUMBER OF
DWELLING
UNITS
PERC. TEST
REMARKS
FLREZONE TYPE 07
E3 YES n NO
Plan Check No ............... ....
BUILDING
FLUM33ING
BEAT & GAS LINE
PENCE
SIGN
I
tRETAINING
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read We 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
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 TIUS PER311T
relating to Workman's Compensation Insurance. AUTHORIZES
ONLY THE
d
by
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a
I
a
he
uth
In
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r
n we r ': on
3f W a G h pa r ton
NOTE: Permit Limit One Year (Except DE51OLITIONS which IVORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
�L lei - al CITY OF
I ED51ONDS
'�'gb�?-'%Fplicant 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,
mw,quees, etc.) will require separate permission.
M
Valuation
43.�e
0 YES E] NO
Fee
0
RM
I /, - I ;5;-Ilf
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his Dep-
uty; and fees axe paid, and receipt is ac-
Imowledged in apace provided.
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