670357.pdfN
r
1�._
POSTED ON IMOLL MAP NO-:
UILDING DIPARTMENT
PERMIT APPLICATION
I
1AME (OR NAME OF B
4A
ffAILING ADDRESS I
400 -5awsel
w,
rAW419"4r1T1
/-/. to I, &)rl
lopl
1i
7W
A
Applicant Fill
Inside Heavy Lines
Ef
MADD
NEW
REPAIR
I V1 RESIDENTIAL
I El NON-RESMENTIAL
-I
r
GAS
LINE
SIGN
RETAINING
WALL
PENCE
( .......... x .......... Ft.)
swim
POOL
EJ
ElDEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
El INSP.
ElALTER
0
El
rUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
PERMIT
NUMBER 670357
SETBACIE REAR YARD SETE
I %
Al
VACANT SITE
El YES 13 NO
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R AV ............ FT. ... �a_rr.
rf,
old
13Y
03
3 1 _T- --- IXYES [3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCy GROUP
[3 YES )ieNo
Plan Check No ................ ...
USE
I—FR—OPOSED
prlea;�e auell1de;z
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacits, abutting -Streets)
BEAT & GAS LINE
PENCE
Vn
t
SIGN
N
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 duly author -
lead agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Coda of the State of Washington
THIS PER311T
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ONLY THE
WORK NOTED
Shall be completed in ninety days; MOVE114N BUILDINGS shall be com-
pleted In NIX months.)
-910—NATURE (OWNER Olt AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
NOTE: Applicant Subject to Plan Cbeck Fee
Pit 6-1107
This Perralt covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways.
marquees, etc.) will require separate permission.
Valuation
Fee
'00
I /-/-. 0�14 0 0 1
APPLICATION APPROVAL
This application is not a perinit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
, IE:vr �
as' � 7
FILE