680034.pdfPOSTED ON KROLL MAP NO.:
PERMIT
680034
BUILDING DEPARTMENT Applicant Fill
L NUMBER
PERMIT APPLICATION Inside Heavy Lines
JOB ADDRESS _rls ,
NAME NAME OF BUSINESS)
9 q, Ir— / 4? 17�
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(OR
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81DE YARD 813-171JACK STREET BET33ACIE RHAR YARD SETBACK
MAILING ADDRESS
8 315-- / 9R �3
USE ZON`11 LUT ARI�A
1
VACANT SITE
1
CITY TIJ�EPHONE 14ygJI;R
0
[3 YES [3 NO
7G
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HEIGHT BUILDING
AREA, VARIANCE NUMBER
11)
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NAME
PLOT PLAN APPROVED
ADDRESS
STREET B/W
EXISTING STREET R/W ............ FT.
DEFICIENCY T3318 PROPERTY
CITY TELEPHONE NUMBER
COMP. PLAN ST. R/W ............ FT.
..........
REMARKS
NAMIC
CHECKED BY
-Z
ADDRESS
MR
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
CITY
I
REMARKS
STATE LICENSE NUMBER CITY _LIOENSE NUMBER
TYPE CONNECTION
VERIFIED BY
Legal Description Of Property (Show Below or Attach Four Copies)
13, eoee-1.9ir e�-. �,OIVIAIY A 49,01 rl OIL/
PERC. TEST
PERMIT NUMBER
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REMARKS
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N
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FIRE ZONE TY PE OF CONSTRUCTION STREET IMPROVED
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0A JAJnq0M1Yh S7-W�, 7-6- gy C41AAS 14
E] YES [I NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
[] YES ij NO
PLAN CHECKED BY
GAS
RESIDENTIAL LINE
13
NEW
RNW3EARKS
NON-RESIDENTIAL 1:1 SIGN
RETAINING
f—I WALL
DEMOLISH
ALTER EXCAVATE PENCE
1:1 OR FILL El ( .......... x .......... Ft.)
REPAIR PRE -MOVE swim
INSP. 1:1 POOL
NUMBER OF STORIES NUMBER OF
DWELLING
0/Q E UNITS ON 2L__
NATURE OF WORK TO BE DONE
p D 1�_> T>0 [Z:T_
Valuation Fee Receipt
No.
Z
Plan Check No ................ ...
PROPOSED USE
BUILDING
PLOT PLAN (Indica wBuilding setoacKs, abutting stre ...
PLUMBING
HEAT & GAS LINE
t
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
56
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; tbat the in-
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- ATMNTION
tating 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 PERIMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
` 0
�n
0
ONLY THE
NOTE: Permit Limit One Year (Except DE31OLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be corn-
pleted in mix months.)
3
DATE SIGNED INSPECTION
DEPARTMENT
CITY OF
V EDDIONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
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.
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.
. !:7 �
7
FILE
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