740493.pdfPERMIT
BUILDING DEPARTMENT Applica1�-
NAME
� NUMBER 740493
PERMIT APPLICATION I Inside HeSOH ! 7�a - r%
ADDRESS
IIr'jff��jME lOR NAME OF BUtl1NEBe)
%�� ^ �t!L • to/Y I ' LOT C VERA " ACTUAL J
m /),( 11 L LOT COYERAOE LOT COYENAOE
MAV L`NQ ADDRESS
G / 7�zZ _ � � ,(�,`}� � • PEIth11SS1IILE HE16}{T PROPOSED HEIGHT
CITY�j�tT/E�LEP-ONE N,ACTUAL LOT AREA TOTAL RLDO. AREA
II 1. qFA LQ / 714 — 76
FRONT SIDE REAR FRONT NIDE REAR
Pl.. Check No ..............
W ADDRESS
LEGAL LOT VARIANCE OR CONDITIONAL USE
O
C3 YES [] NO PERMIT NUMBER
UPLANNING
DEPT. APPROVAL _ DATE:
CITY
TELEPHONE NUMBER
STREET R/W
I
shell be completed In ninety days; MOVED -IN BUILDINGS shall be cone.
HEAT k GAS LINE
NON-RESIDENTIAL
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME
FENCE
COMP. PLAN BT. R/W ............F'T. ............FT.
j, /
(2, yt
REMARKS
is ADDRESS
❑
ICHECKED BY
U
CITY
TELEPHONE NUMBER
SWIMMING POOL
I
❑
PENCE
V
METER SIZE I SERVICE SIZE I CLEARANCE
I CHECKED BY
O
r
w
I hereby acknowledge that I have read thlo application; that the In-
TOTAL AMOUNT DOE
Pl.. Check No ..............
ized agent of the owner. I agree to comply with city and elate laws re".
(3 YES NO
O
NEW
will be employed In Viol""' of Ne Labor Code of the State of Washington
RESIDENTIAL
ElGAS
LINE
PLAN CHECKED IIT
ONLY HE
shell be completed In ninety days; MOVED -IN BUILDINGS shall be cone.
HEAT k GAS LINE
NON-RESIDENTIAL
❑
SIGN
FENCE
ElADD
❑
DEMOLISH
❑
RETAINING
LL NING
REMARKS
❑
ALTER
SWIMMING POOL
❑
PENCE
NOTE: Applicant Subject to Plan Check Fee
PRE -MOVE INSPECTION
❑
ORFILL
...........Ft.)
El
REPAIR
❑
PRE-INSP.
SIVIM
❑
POOL
NUMBER OF BTORIE8
NUMBER OF
DWELLING
UNITS
I hereby acknowledge that I have read thlo application; that the In-
TOTAL AMOUNT DOE
Pl.. Check No ..............
ized agent of the owner. I agree to comply with city and elate laws re".
BUILDING
O
F
W PROPOSED USE
will be employed In Viol""' of Ne Labor Code of the State of Washington
THIS PERMIT
6•%O,
AUTHORIZES
PLUMBING
ONLY HE
shell be completed In ninety days; MOVED -IN BUILDINGS shall be cone.
HEAT k GAS LINE
PLOT PLAN (Indicate Building setbacks, abutting street.)
it NATURE (O{YNEI( OR AGENT)
FENCE
INSPECTION
SIGN
C
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
NOTE: Applicant Subject to Plan Check Fee
PRE -MOVE INSPECTION
775-2525
This .'.nail covers work la La donee private property ONLY.
EXCAVATION OR FILL
I hereby acknowledge that I have read thlo application; that the In-
TOTAL AMOUNT DOE
tormatlon 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 elate laws re".
Iating construction; sad m doing the work authorized thereby no person
ATTENTION
will be employed In Viol""' of Ne 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 HE
shell be completed In ninety days; MOVED -IN BUILDINGS shall be cone.
WORN NOTED
plated In is ...the.)
it NATURE (O{YNEI( OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
C
CITY OF
ED51ONDS
NOTE: Applicant Subject to Plan Check Fee
775-2525
This .'.nail covers work la La donee private property ONLY.
Any const ruMlon on the public domoln (curbs, sidewdriveways,ewaylks, driveways,
maraneen, etc.) wan " Sre separate permle.lan,
YES [] NO
Valuation
I �i, r 00 1
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.
DITOR'S SifiNATU //A•--4,
2&
DAT
FILE
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