670049.pdfI
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAM (OR NAME OF BUSINESS)
IT V L- I � (-- P_ -r-
MAILING ADDRESa
Z 7 /96
-UITY TELEPHONE NUHRER
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14AME
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ADDRE138
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CITY
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B)-DO� �uPPL
ADDRESS
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2_ 41 41b L-�- S_ G(j
CITY
Ttz
TELEPHONE NUMBER
PV -s--, IS./
STATE LICENSE NUMBER
CITY LICENSE NUMBER
122-3a)
3152-
Legal Description of Property (Show Below or Attach Four Copies)
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GAS
LINE
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NON-RESIDI TIAL
SIGN
D�V�
RETAINING
F�
DEMOLISH
WALL
FAALTER
D
EXCAVATE
OR FILL
D
PENCE
( x Ft.)
.......... ..........
REPAIR
1:1
PRE -MOVE
INSP.
swim
POOL
TUMBER OF STORIES
NUMBER OF
DWE1&JNG
UNITS
L )
NUMBER 670049
J, 5- ('o
VACANT SITE
YES 0 N
VARIANCE NUA R
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. .......... 1".
0 YES 0 NO
9
Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS rJNE
PENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A51OUNT 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-
ize-d agent of tile owner. I agree to comply with city and state laws r0gu-
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
THIS PERMIT
relating to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Vimit One Year (Except DEMOLITIONS which
ONLY 11WE
WORK NOTED
Shall be completed In ninety days; MOVED -IN BUILDINGS sball be com-
pleted In SIX months-)
SIG�,ATURE (OWNER OR AGENT)
DAT ' BIG
N7677
INSPECTION
DEPARTMENT
CITY OF
EDINIONDS
NOTE: APACOW Subject to Plait 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,
marquees. etc.) will require separate permission.
0 YES [:I ITO
Valuation I Fee
::7 CPA-0" I—e-4
C?
Z
N
No.
0
APPLICATION APPROVAL
This application is not a perinit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
DIRECTOR'S ION �T�
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000,
FILE
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