670413.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
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CITY
Applicant FIR
Inside Heavy Lines
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or
NEW
RESIDENTIAL
F-1
GAS
LINE
NON-RESIDENTLhL
14
SIGN
DADD
RETAINING
ElDEMOLISH
El
WALL
EXCAVATE
FENCE
ALTER
M
OR FILL
( x Ft.)
E] REPAIR
ED
PRE -MOVE
INSP.
.......... ..........
swim
POOL
;UMBER OF' STORIES
NUM13ER OF
DWELLING
UNITS
PERMIT
NUMBER
02
70413
VACANT SITE
0 YES 13 NO
VARIANCE NUMBER
EXISTING STREET R/W ........... YT. DEFICIENCY TIUS PROPERTY
COMP. PLAN ST. RAV ............ Fr.
0 YES 0 NO
0
AX4'5i�r S16-4v
Q -
Plan Check No .....................
'�60C4-7-e—
IA; USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
Yak _4VA4_— '5,
DEMOLITION
PRE -MOVE INSPECTION
`V
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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 author-
ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorized thereby. no person
ATTENTION
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
shall be completed in ninety days: MOVED -IN BUILDINGS aba.11 be com-
ONLY THE
WORK NOTED
pleted In six months.)
INSPECTION
SIONK-T—URE (OWNER OR '%GENT)
DATE SIGNED
DEPARTMENT
CITY OF
EDAIONDS
]VOTE: Applicant Sitbiect to Plats Check Fce
PR 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) win require separate pertnisslon.
ID 0
E3 YES 13 NO
Fee
-5-1
I 5-.-On I
Win
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.
I
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OECORD OF INSPECTIONS
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Date Passed;
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