670257.pdf03
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OFMUSINESS)
'PTAi"
ILING ADDRESS
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CITY �PHGKE_NUMBXR
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CITY TuaXPA101iE NUMI
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STATE LICENSE NUMBER CITY LICENSE NU
2- 23 - 0 f - 57-6- a P
Legal Description of Property (Show Below or Attach Four Coplo
aNEW
El ��
DALTER
1:1 REPAIR
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NO.:
PERMIT
NUMBER
.)70257
Q YES 13 NO
i;�SfXG STREET jj/W ............ FT DEPICrENCY TUIS PROPERTY 0
COUP. PLAN ST. R/W ............ IT -
REMARKS
CHECKED BY Z
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RESIDENTIAL
NON-RESIDENTIAL]
D
SIGN
DEMOLISH
RETAINING
WALL
XCAVATB
E OR FILL
F
PENCE
FPRE
-1
-MOVE
INSP.
F1,
swim
POOL
DWELLING
I UNITS
NATURE OF WORK TO BE DONE
If Q A( PlAA1
PROPOSED USE
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ey
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I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duly allthOr-
lzed agent of the owner. I agree to comply with city and state laws regu-
I&tltlg construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation insurance.
NOTE: Permit Limit one Year (Except DE31OLITIONS which
shall ho completed In ninety days; JUOVED-IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This re mit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, ete.) will require separate permission.
[:] YES
Plan Check No.
[] NO
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
0 YES 13 NO
Valuation
0 1 la,
TOTAL A31OUNT DUE j
ATTENTION APPLICATION APPROVAL
THIS PEnMIT This application is not a permit until
AUTHOIUZES signed by the Building official or his Dep-
ONLY THE
WORIE INOTED uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION
DTT7,&' 111UN
DEPARTMENT
CITY OF DATE
EDDIONDS
PR 6-1107
FILE
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