670210.pdfI a
BUILDIN G DEPARTMENT Applicant Fill
Inside Heavy Lines
17ERET APPLIC)
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Property (Show
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IDE YARD BE
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MAP NO.: PERMIT
NUMBER 670211 0
STREET SETBACK YARD SETBACK
A S- I M i tl /_5— mn ; 0Z
LOT AREA VACANT BLTAI
1 0 YES M40-
"T"LDING �%REA I VARIANCE NUMBER .1 Ck
IONE NO �ER EXISTING
- I PROPERTY
STREET R/W ............ FT- DEFICIENCY THIS
COMP. PLAN ST. R/W ............ FT. ............ FT.
0
REMARKS
CHECKED BY
METER SIZE SERVICE SIZE CLEARA.NCE
CHECKED BY
BONE NUMBER
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WTIMMrIER
REMARKS
"Il,
[3 YES [3 NO
RESIDENTIJ
0
GAS
LINE
NEW
ADD
ALTER
TIAL
FNON-RESIDI
SIGN
RETAINING
WALT
PENCE
( .......... x .......... Ft.)
DEMOLISH
EXCAVATE
OR FILL
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF
DWELLING
UNITS
I
I -Ian Check No .....................
PROPOSED UBE
BUILDING
abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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 duty author-
ized agent of the owner. I agree to comply with city and state laws regu-
ATMNTioN
lating construction; and in doing the work authorized thereby, no person
will be employed In violation Of the Labor Code of tha.State of Washington
TIUS PERMIT
relating to Workno6a'g Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITION'S which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
JIGNATURE (OWN zK un DATE SIGNED
INSPECTION
Dx;
—1 1-2.
DEPARTMENT
10 �14
CITY OF
EDATONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This rernAt covm 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 NO
Valuation I Fee
I
�IM
I '7,5_0 147�-P-
APPLICATION APPROVAL
This application Is not a permit until
signed by the Duilding Official or his Dep-
uty; and f ees are paid, and receipt is ac-
knowledged In space provided.
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