680004.pdf. Is
BUIL=ING DEPANTMENT AppUcant FIU
PP Inside Heavy Lines
PERMIT APPLICATION
N AM — R! OFB91
AME (OR NAME OF BUSINESS)
LING ADDRESS
7 0. C4—)
-U,—Ty TELEPHONE NUMBER
P NO.:
NUMBER
0 D
DE YARD SETBACK I STR ET aiswmACK
TE —ZONE 10T ARE
VACANT SITE
13 YES [3 NO
VARIANCE NUMBER 96
NAME
PLOT PLAN APPROVED
ADDR9138
STREET R/W
EXISTING STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
I TELEPHONE NUMBER
..F-r. ........... FT.
... COUP. PLAN ST. R/W...
REMARKS
NAME
NEW
ADD
FALTER
FREPAIR
z
CHECKED BY
TELEPHONE NUMBER
METER SIZE SERVICE SIZE CLEARANCE
CHECKED By
NUMBER
CITY LICENSE NUMISNA
I
14
REMARKS
of Property
(Show Below or Attach Four Copies)
TYPE CONNECTION-
VERIFIED BY
PERC. TEST
PERMIT NUMBER
REMARKT_
A-
FIRE ZONE TYPE) OF CONSTRUCTION STRE T IMPROVED
YES 13 NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
0 YES NO
RESIDENTIAL
El
GAS
E
PLAN CHECKED BY
Li NON-RESIDENTL&L
SIGN
DEMOLISH
RETAIMNG
WALL
EXCAVATE
OR FILL
VENCE
( ........ . x .......... Ft.)
PRE -MOVE
INSP.
SWIM
POOL
un—iEs-
NUMBER or
DWELLING
UNITS
rian Check 'No ............... ....
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
0
HEAT & GAS LINE
PENCE
t
13ION
N
RETAINING WA.LL
SWIM NG 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-
Ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
latlng 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 Workmea'a Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DE51OMTIONS which
WORK NOTED
shall be completed in ninety days; MOVEDAN BUILDINGS shall be com.
pleted in six months.)
-6-I—ONATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDDIONDS
NOTE: Applicant Subject to Plan Check Fee
Pit 0-1107
This Permit covers work to be done on private property ONLY.
Any construction an the pnbUc domain (curbs. sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
No.
i
02-
=1 Fit i i
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.
�YURE
DI 188117 z
n' K0_
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