670490.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME 1011 NAAIE, OF BUSINESS)
Pau! R. PhiAlAns
MAILING ADDRESS
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TELEPHONE NUMBIfR
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TELEPHONE NUMBER
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16 page 54
Snohomish
Count,)r
0
NEW
RESIDENTIA :LTIAL
GAS
LINE
NON -RESIDE
F�
ION
FEADD
El
RETAINING
WALL
0
DEMOLISH
EXCAVATE
FENCE
ALTER
D
OR FULL
( x Ft.)
REPAIR
PRE -MOVE
INSP.
.......... ..........
SWIM
POOL
TUMBER OF STORIES
NUM33ER OF
DWELLING
UNITS
C )c 10' 400177W
M17, 6r� CULPDXT
PROPOSED USE
:! 5 -rb I A W"I
PLOT PLAN (Indicate Building setbacRi, abolting st
Dej I' Qf IS
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PERMIT
NUMBER b70490
2-SI
a4:0 tq 2=
K I
.rBAC STREET SFUBACK RE YARD SETBACK
LOT AREA VACAWX 01
I I
YES NO
BUILDING AREA WARIANCE -NUMBER aw
EXISTING I STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ........ ..
REMARKS
CHECKED BY 0
Z
SERVICE SIZE I CLEARANCE CHECKED BY
VERIFIED BY
PERMIT NUMBER
TYPE OF
j_U__ I _V1 I cl YES No
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[:I YES _f__40
B
PLAN CHECKED
REMARKS
Plan Check NO ...... ...............
BUILDING
PLUMBING
I
t
HEAT & GAS LINE
PENCE
SIGN
I
RETAINING WALL
SWIMMING POOL
DE14OLITION
PRE.ATOVE INSPECTION
EXCAVATION OR FILL
TOTAL A.NIOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given In 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-
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
TIUS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ONLY THE
JVORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
3IGNATUi �(OWNE�ROR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
ED31ONDS
NOTE: Applicant Sitbject to Plat; Check Fee
PR 6-1107
This permit covers work to be done on privnto property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Fee
'C25-0 1 3t &0
140.
13 a 0" 1 (,qo,7 0'
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.
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