660541.pdfr X",
postrED ON KROLL MAP NO.: PERMIT
NUM13ER 66054
BUILDING DEPARTMENT Applicant Flu jE:7 I
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
NAME (OR NAME OF BUSINESS) / q s—/ S f o
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X-A 0
TELEPHONE NUMBER
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TELEPHONENURff—ER
In
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TELEPHONE NUMBER
Lseiow or Attmen 1four uoines;
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RESIDENTIAL
El
GAS
LINE
NEW
NTIAL
0
NON -RESIDE
SIGN
17
RETAINING
WALL
DEMOLISH
DALTER
D
EXCAVATE
OR FILL
PENCE
( .......... x .......... Ft.)
REPAIR
PRE -MOVE
SWIM
POOL_
INSP.
NUMBER OF
DWELLING
UNITS
I
I
USE ZONE
LOT AREA
-
VAC SITE
`
Z
1
0 YES [3 NO
HEIGHT
�G
I
I BUILDINI
1MA
VARIANCE NUM-BEK
PLOT PLAN APPROVED
ST PET R/W
EXISTING STREET R/W ............ FT.
DEFICIENCY THIS PROPERTY
0
COUP. PLAN ST. R/W ............ FT.
........... FT.
REMARKS
CHECKED M
Z
I
PERC. TEST PERMIT NUMBER
I REMARKS
[] YES El NO
PLAN CHECKED By
REMARKS
Plan Check No .........
I LD G
BUILDING
B I
U
L U MB N G
PLUX NG
P N
AS LINE
HEAT & GAS LINE
H E A T G
N C E
FENCE
F E
t
N
I
N
SIGN
S I G
RETAINING WALL
E T A NG WALL
N
R I I
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
E E XCAVATION OR FILL
. JOU.,T DUE
TOT L I
TOTAL AMOUNT DUE
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 allulor.
Ized agent of the owner. I agree to comply with city and state laws regu-
lating conBtructJon; 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 Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days: MOVED -IN BUILDINGS shall be com-
nletedliMix months.)
NOTE: Applicant Subject to Plan Check Fec
This Permit covers wort, to be done on prhnte property ONLY.
Any construction an the public domain (curbs, sidewalks. driveways,
marquees, etc.) will require separate permission.
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDATONDS
PR 8-1107
I
10 YES [j NO
Valuation I Fee I Receipt No.
00,
WE
I //, C-o I
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
19 �D
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