670076.pdf%. ; 'i
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POSTED ON KROLL MAP NO.
BUILDING DEPARTMENT Applicant Fill.
Fill
Inside HeavY Lines JOB ADDRESS
PERMIT APPLICATION I rl , - . I` I __
NAPAM (OR NAME OF BUSINESS)
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cc 'MAILING ADDRESS
1 74?
91 ISO /?7
CITY TZ". I
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ADDRESS
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CITY
Se,g
STATE LICENt34 NUMBER CITY LAUZ�019 NUALISISU
IL �L, 3 -0 / Z
Legal Description of Property (Show Below or Attach Four copies)
/_ 6 7' 6
1?e / 7/5 e xkl 07 _r_Z54_�_
131 NEW
RESIDENTLA
GAS
LINE
NON-RESIDI TLALL
SIGN
0
Acj
RETAIMNG
DEMOLISH
WALL
ElALTER
EXCAVATE
OR FILL
PENCE
( .......... x Ft.)
..........
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF
air_�;_ORIC
DWELLING
UNITS
TO BE DONE
/07�n 'p- 4e') *�v
PERI&IT
NUMBER 6-70076
1 1
YES 0 NO
EXISTING I STREET R/W ........... YT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT.
[] YES [] NO
Plan Check No ...................
BUILDING
PLUMBING
n at
PLOT PLAN (Indicate BuIldl P a books, abutting streets)
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
7>
SWIMMING POOL
0
DEMOLITION
PRE -MOVE INSPECTION
JIV
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowled90 that I have read this application; that the in-
formation given In 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-
ATTENTION
I&tIng 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 PEnbirr
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Pef,11it Limit One Year (Except DEMOLITIONLI which
1*VORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com.
plated In six months.)
3IGNATU?,E (OWNER OR AGENT) DA E SIGNED
INSPECTION
DEPARTMENT
0/10�
CITY OF
EDNIONDS
NOTE: Applicant Sitbject to Plait Check Fee
PR 6-1107
This Permit covers work to be done on privets property ONLY.
Any construction on the public domain �curba, sidewalks, driveways,
raarquces, etc.) win require &eparste pemilation.
El YES 13 NO
Fee Receipt No.
jg 0
APPLICATION APPROVAL
This application is not a pennit until
signed by the Building Official or his Dep.-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
7�
0
FILE
a
6-70076
7' 2F��
PR 6-4389
8319 /7 S, W,
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Furnace & Fuel Line 6,
Final
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