670553.pdfr ;
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OSTED ON KROLL MAP NO.: PERMIT
670553
BUILDING DIIARTMENT7 ',,,,11cant FBI
JOB ADDRE138
IT PPLIJ Ingde Heavy Lines
REMIT APPUCAM,
el 4?.2 ) - / el� - - -4 - Yd- - I
:DE YARD SETB - ACK STTIEET SETBACK REAR YARD SETBACK
A�. r-N A-.-. V_r_% AAAJ
JSE ZONE LOT AREA VACANT ZWK19
[3 YES 13 NO
I RMLWDING 'AREA VARIANCE NUMBER ;W
EXISTING -STREET R/W ............ FT. DEFXCIEiNCT THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ........... I.T.
13 YES 0 NO
F NEW
RESIDENTU
M
GAS
LINE
NON-RESID1 TIAL
SIGN
RETAINING
FDEMOLISH
WAT.T.
EXCAVATE
PENCE
ALTER
OR FULL
( x Ft.)
........ . ..........
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF
DWELLING
UNITS
rian check No .....................
POSED USE
BUILDING
T PLAN (Indicate Building setbacks, abutting streets) PLUMBING
HEAT & GAS LINE
PENCE
t SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In- TOTAL A31OUNT DUE
formation given to 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 regu- ATTENTION
'u
lattrig construction; and In doing the work authorized theroby, no person
will be employed In violation of the Labor Code of the State of Washington TIUS PERMIT
relating to Workman's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORIE NOTED
snail be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
�eAvr ;122AV490 I A/02/1
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NOTE: Appficant Subject to Plan Check Fee
This permit covers work to be done On private property ONLY.
Any construction On the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
PR 6-1107
Valuation
STREET IMPROVED
0 YES 1:
Fee I Receipt No.
1.0
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.
I . 4 14
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FILE
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