660594.pdf-BUILDING DEPARTMENT Applicant FIR
PERMIT APPLICATION Inside Heavy Lines
X KROLL MAP NU.: PERMIT
NUMBER 660594
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NAME
PLOT PLAN APPROY-ED
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ADDRESS
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Ffi,!��bfO(ZA� 1P)_ E STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
CITY xELEPRONE NUMBER rz
COUP. PLAN ST. R/W ............ FT.
11,417 REMARKS
NAME
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—A DRESS J- 4E5T 2 CHECKED BY
METER SIZE SERVICE SIZE
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CITY TELEPHONE NUMBER a J.CLEARANCE
MARKS
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CITY LICENSE NUMBER
STATE 1.1unribla livaBun
TYPE CONr�ECTION VERI
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Legal Description of Property (Show Below or Attach Four Copies) "�s 4zx,� 1 1
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FIRE ZONE TYPE OF CONSTRUCTION
2 STREET IMPROVED
YES 046�
SPECIAL INSPE� 7ORQUIRED JOCCUPANCY GROUP
0
Ej YES 0
PLAN CHECKE
GAS
NEW RESIDENTIAL LINE REMA
NON-RESIDENTIAL El SIGN
ADD RETAINING
DEMOLISH WALL
F� ALTER EXCAVATE FENCE
OR FILL .......... x .......... Ft.)
REPAIR PRE-11OVE swim
INSP. POOL
NUMBER Or STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation Fee Receipt No.
Irl'
Plan Check No ........
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BUILDING
B U L
P G
PLUMBING
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G A IN E
HEAT & GAS LINE
RE & 8 L
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FENCE
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SIGN
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RETAINING WALL
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SWIMMING POOL
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DEEUMOLITIO N
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CTIO N
PRE -MOVE INSPECTION
PRE -MOV E INS E
EE
FILL
EXCAVATION OR FILL
A A rJON
XC V 0
TOT I
, tOUNT
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 author-
Ized agent of the owner. I agree to comply with city and state laws regu-
AT=NTION
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
THIS PERMIT
relating to Workmen's Compensation Insurance.
I
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
[I.E (OWNER OR AGENT) DA NED . mspncTio
DEPARTMENT
,Z#._ 12 0�
62
Mj CITY OF
EDIVIONDS
NOTE: Applicant Subject to Plan Check Fee PR 0-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curb%, sidewalks, driveways,
marquees, etc.) will require separate permission.
1/17
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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. . . ....... ....... . . . . . . .
U I D N
BUILDING DEPARTMENT Applicant Fill
POSTED ON KROLL MAP NO.:
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PERMIT
I NUMBER 660594
PERMIT APPLICATION Inside Heavy Lines
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JOB ADDRESS
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NAME (OR NAME OF BUSINESS)
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SIDE YAR
USE ZONE
STREET SETBACK
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LOT AREA
REAR YARD SETBACK
VACANT SITE
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MAILING ADDRESS
MAILING
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CITY TELEPHONE NUMBER
1.,4,Z)5�FA
0,100-4
HEIGHT
BUILijING AREA
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VARIANCE 14UMB Ak
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NAME
14AM
fi
IfIlle- fAr 4/9 A lid
PLO A 'PRO D
A M I
DDHEBS
TTFREEYA/W
E)USTIING STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.—
REMARKS
1Z 10 0, Tk_
CITY TELEPRO14B NUMBER
,�57
NAM
CHECKED BY z
ADDRESS
'70 60 1�15-
METER SIZE SERVICE,SIZE CLEARANCE
YA
7!KL 19
CITY
TIS "PHONE NUMBER
REMARKS
n�r&,P� T,70-VoIRM WTTMR�
I V= �EJENSE NUM1319K
,gal Description of rroperty (Snow Beiow or au
Z_
0 YES
RESIDENTIAL 111
GAS
LINE
NEW
NON-RESIDENTI&Lj
r I
SIGN
RETAINING
WALL
DEMOLISH
EXCAVATE
FENCE
ALTER
I%.)
OR FILL
( .......... x ..........
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
;UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
qATURE OF WORK TO BE DONE
4z�
OF
"'� JV'��'t
rian Check No .....................
BUILDING
PLOT PLAN (Indicate Building setbackA, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
r
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT 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 author-
lzed agent of the owner. I agree to comply with city and state laws mgu-
ATTENTION
lating construction; and in doing the work authorized thereby. nn person
will be employed In violation of the Labor Code of the State of Washington
THIS PEIDIIT
relating to Workmen's Compensation Imurance.
AUTHORIZES
ONLY =
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall he completed in ninety days; MOVED-1.,i BUILDINGS shall be com-
pleted In six months.)
3IGNATURE (OWNER OR AG DATW SIGNED INSPECTION
DEPARTMENT
L2 42- _�z
CITY OF
EDIVIONDS
NOTE: Applicant Subjcct to Plan Check Fee
PH 0-1107
This rermft covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees. etc.) will require separate permission.
[3 YES
Fee I Receipt No.
I cl-,, r �� 0 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.
FILE