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BUILDING DEPARTMENT Applicant Fill
PER11 1 ��PLJJ
I®NInside Ileavy Lines
I NAM OR NAMD}3BItIlEO� .S
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POSTED ON KROL MAP NO.: PERMIT I O�!D NUMBER
JOB ADDRESS ,
SIDE YARD SETBACK STREET SETBACK I REAR YARD SETDACK
USE 'LONE LOT AREA VACANT SITE
--PS I I P0 YES ❑ NO
EXISTING STREET R/W ..'[..� ....FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ....FT.
REMARKS Driveway slopes not to exceed those
U PC, 1"t-7 d
OF
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YES ❑ NO
RESIDENTIAL
❑
6A8 YES XNO
LINE BY
�,N'�
NEWI
NON-RESIDENTIAL
El
PLAN CHECK
SIGN
THIS SITE IS LOCATED IN THE
ADD
RETAINING REMARKS
WAIT'
Cl I y OF LUMONDS. LOCAL SALES
DEMOLISH
FENCE
TAX SHOULD BE CODED 31.04•
ALTER
❑
❑
Ft. )
ORFILL
x..........
❑ REPAIR
❑.
PRE -MOVE
O
Pwim
OOL
(UMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
Plan Check No .....................
BUILDING
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
�t
RETAINING WALL
N
`o` I
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
) 1�
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I hereby acknowledge that I have rend 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 stale of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
ILGN URE (OWN OR AGENT) DATE SIGNED
Lle�-71
NOTE: Appl;c'bnt Subject to Plan Check Fee
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.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDDIONDS
PR d-1107
Valuation I Fee
.LA
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.
FILE
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RECORD OF INSPECTIONS
To
Date Passed
_ ... Foundation
Plumbing (Partial)
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P 'nP
(Rough), O
_ ?/ �9
Frameor W
_ Furnace & Fuel Lines
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N ..0 f, P,,.IT
.. " - T,r , .r i 2^.' c:, RECORD OF INSPECTIONS It
lit
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Date Passed
It d A! �«
t Drainage ;k
k IT Sewer
Parking
_. ;.Landscaping
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{ t Fire Dept
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