680136.pdfI
BUILDING DEPARTMENT
PERMIT APPLICATION
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Applicant Fill
Inside Heavy Lines
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RESIDENTIAL
GAS
IJNE
NEW
ED
NON-RESIDENTIAL
El
SIGN
ADD
FDEMOLISH
RETAINING
WALL
ALTER
EXCAVATE
PENCE
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OR FILL
( .......... x .......... Ft.)
REPAIR
1:1
PRE -MOVE
INSP.
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POOL
IUMBER OF STORIES—
NUMBER OF
DWELLING
UNITS
i
PERMIT
NUMBER 680136
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SETBA CK TRE REAR YAIC
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<�_ 1Low AREA VACANT 13r
1 13 YES
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EXISTING -STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... X"r- ....... -FT.
[] YES [3 NO
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Plan Check No ..................
PROPOSED USE
BUILDING
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PLOT PLAN (Indic Building setbacks, abutting streets)
PLUMBING
04
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby ack owledgo that I have read this application; that the In-
formation given Is 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
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
TIHS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be oorn-
pleted In six months.)
8 GNATU ER OR AGE 9 JJA'X� SIGNED
I NT.)
INSPECTION
'�PE*OW—N—
DEPARTMENT
CITY OF
EDIVIONDS
NUT'E: Applicant Subject to Plan Check Fce
PR 6-1107
This Permit coven work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require sepamte permilasion.
[3 YES [3 NO
Valuation
575-0. o b 1 5-
1 5-.0() 1W_8_V_3_
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Off Icial or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
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