670227.pdfI . I
BUILDING DEPARTMENT I ApplicantFill
PERMIT APPLICATION Inside Heavy Lines
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ADDRESS
CITY
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or
RESIDENTIAL
El
GAS
LINE
NEW
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ADD
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RETAINING
WALL
ALTER
DEMOTASH
EXCAVATE
PENCE
OR FILL
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REPAIR
PRE -MOVE
SWIM
POOL
INSP.
IUMBUR OF STORIES
NUMBER OF
/011 10
DWELLING
uNrrS
PERMIT
NUMBER 670227.
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YES
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EXISTING STREET R/W ...... -FT. DEFICIENCY THIS PPOPERTT
COMP. PLAN ST. R/W ............ FT.
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[] YES
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Plan Check No .............
Valuation
Fee
Receipt No.
PROPOSED USE
BUILDING
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PLOT PLAN (IndlcateT,11�ln
A/ 9f �setbacka, abutting Streets)
PLUMBING
f
02
ft
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
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DEMOLITION
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PRE -MOVE INSPECTION
_;�p
EXCAVATION OR FILL
I hereby Acknowledge that I have read this application; that the In.
TOTAL AMOUNT DUE
r
I d-
formation given In 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-
ATMIMON
APPLICATION APPROVAL
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
yo
TRIS PEILI%nT
This application is not a permit until
relating to Workmen's Compensation Insurance.
miaung to
AUTHORIZES
signed by the Building Official or his Dell-
41 Umit One Your (EXCept DE31OLITIONS which
NOTE: Per
�pl*
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt Is ac-
shall be completed In ninety days; MOVZD-IN BUILDINGS shall be com-
Imowledged in space provided.
Lmit
I
pleted In six months.)
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SIGNATURE (OWNER OR AGENT)
U (0
DATE UIGNED
INSPECTION
—DIRECTOR'S SIGNATUJU
LQ-71067
DEPARTMENT
CITY OF
EDINIONDS
NOTE; Applicant Subject to Plan Cbeck Fee
-
Pn 6-1107
This Permit covers work to be done on private property Oiwy.
Any construction on the public domain (curb$, sidewalks, driveways.
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marquees, etc.) will! require separate permission.
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IN THE COUNTY OF SNOBOMISHV STATE OF WASHINGTON ...
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All that portion of tract eighty�four (84)t Plat of Meadowda er
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Pige 38t records of said countyp deso
r;:., ribedras follows:
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Beginning.at t,he southeast ogrner of Tract 84; thence north 180
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thence west on a line parallel..to,the north bounIl ne
fe
to"
.,.a point on,the western boundary of said tract; hence south
t to
and east:following the southern boundaryL I I
LI line of said t"rao
the point of beginning,
77�
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