670237.pdf. .... . ... . .. . . . .. .......
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BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME, (Ott NAME OF Nusl"Sb��
Z
I
—0/_
POSTED ON KROLL MAP N��;- PERMIT
// r 0 NUMBER 670237
JOB ADDRESS q
97 e 4 aa V 0 A. Ld
SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK
'25,m),N M;,N( q
USE ZONE LUX AREA VACANT 13LWJS
13 YES [3 NO
I BUILDING AREA I VAMADICE NU �rn 14
�/ DEFICrENCY TMS PROPERTY
TELEPHONF, NUMBER EXISTING STREET R/W,;.O�ePT. 0
COMP. PIA
REMARKS N ST. R/W
CHECXMM�%Y
of Z
0 1 W
METER SIZE I SERV`IqE SIZE CLEARANCE CH1K9= BY
TlGJ.d3VJ4,U 3�QUMBER X6 r, ( -
to L+ A`
,R I CITY Lam 914 kJJS 14UMBER
or Attach FOUIr Copies)
I
E] YES [] NO
Ef"NEW
an�ESIDENTIAL
,GAB
LINE
ON-RESIDENTLILL
SIGN
ADD
RETAINING
FDEMOLISH
WALL
EJALTER
EXCAVATE
PENCE
0
OR FULL
D
( x Ft.)
REPAIR
PRE -MOVE
INSP.
1:3
.......... ..........
SWIM
POOL
NUMBER OF
DWELLING
UNITS
Plan Check No ............... ....
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks. abutting streets)
HEAT & GAS LINE
PENCE
SIGN
z�
RETAINING WALL
SWIMMING POOL
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 rogu-
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 Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIEE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
OWNER Q# AOENT)
DA SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDDIONDS
NOTE: Applicant Subject to Plan Check FCC
PR 6.1107
This Permit covers work to be done on privets Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
[] YES [] NO
Fee
7f -To I :31qo
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.
D117C'�T�lt , SIGN
;?�14
FILE
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