670587.pdf-71—OSTED ON KROLL MAP NO.: PERMIT 67058
BUILDING DEPARTMENT Applicant Fill rTUMBER
PERMIT PPLICATI N
NtA"R (0 OF BUSINESS)
I1JNG ADDRES
W
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inside Heavy Lines _jCB_AbDiRESS C- ke-k- � :3��
0 A,�J t-r% A— 6 tbAy-i
UBE Z014N LOT AREA BIW11,
13 YES 0 NO
VARIANCE NUMBER
T R EL r
EMS77NG STREET n/W
E 87 7N G a
n/W
!PHONE NUMBER
S_
-A N T R/W
COMP. PLAN ST. R/W J
C OM P P
RM
_E MA RV
-TITM--ARKS
M TER SIZE SERVICE
E R
DPHONE NUMBER
REMARKS
LICENSE NO �ER
YPIG CONNECTION
T Ty I
Inch Four Copies)
3 / A I
LPERC. TEST
[j YES
RESIDENTIAL
D
GAS
LINE
NEW
NON-RESIDENTIA.L
SIGN
DRETAINING
WALL
DDEMOLISH
ALTER
EXCAVATE
OR FULL
PENCE
( x Ft.)
.......... ..........
REPAIR
PRE -MOVE
INSP.
swim
POOL
NUMBER OF
DWELLING
-1/
UNITS
Plan Check
PROPOSED USE���
4e
_C, BUILDING
PLOT PLAN (indicate Building setbacks, abutting streets) PLUMBING
\3
TYPE OF
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I
TOTAL A31OUNT DUE
I hereby acknowledge that I have read this applittation; that the In-
formation given Is correct; and that I am the owner, or the duly author-
ized agent of tho owner. I agree to comply with city and state laws rcgu-
ATTENTION
kiting construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed in ninety days; J%IOVED-IN BUILDINGS shall be com-
pleted In six months.)
INSPECTION
RE (OWNER Olt AGENT)
DAT 8 IGNED
4
PC
DEPARTMENT
CITY OF
EDIVIONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
Thin Permit covers work to be donj on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate permission.
DEFICIENCY THIS PROPERTY
/19 ..PT.
CHECKED
2:
ra
ARANCE
C
[3 YES 13 NO
Fee
PIL
I � P _6�1 ro I Y/173
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-
Imowledged in space provided.
.1
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