680197.pdff
BUILDING DEPARTMENT Applicant FM
PERMIT APPLICATION Inside Heavy Lines —j 0-3
NAM (OR NAME OF BUSINESS)
4f /7 a t- Z e _� A e r? Mil
MAILING ADDRESS
12 6 2- �? — P I t"V _U
CITY TELEPHONE NUMBNR
F d' pl�
l NAME
-JS 71 - H 'h
R ADDRESS
CITY TELEPHONE NUMBER
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STATE LICENSE NUMBER CITY LICENSE NUMBEIi
. 2 3 - j!q/ - f. 44 0.1
Legal Description of Property (Show Below or Attach Four Copies)
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RESIDENTIAL
I
n
GAS
LINE
NEW
NON-RESIDENJIAL
EJ
SIGN
DADD
RETAINING
EJDEMOLISH
WALL
E]
EXCAVATE
FENCE
ALTER
D
OR FILL
( x Ft.)
REPAIR
1:1
PRE -MOVE
INSP.
......... . ..........
SWIM
POOL
FUMBER OF STORIES
NUMBER or
DWELLING
UNITS
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MAP NO.'. PERMIT
AC NUMBER 680197
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CK STREET SETBACK REAR YARD SETBACK
LOT AREA VACANT SITE P4
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YES 13 NO
I 13UILDING AREA I VARIANCE NUN
""1V
EXISTING STREET R/W .4-9 ... FT- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W .6L��.FT. A2 FT.
REMARKS
Driveway slopes not to exceed those
indicated on Standard Drawing #103.
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ZONE I TYPE OF
0 YES [] NO
Plan Check No ................. ...
BUILDING
PLUMBING
HEAT & GAS LINE F1
PENCE
t
N
SIGN
RETAINING WALL
SWIMMING 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 In 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 rega- ATTENTION
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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 THIS PERMIT
reiallng; to Workments Compenzatlon Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS wh Ich WORK NOTED
shvAl be completed In ninety days: MOVED -IN BUILDINGS shall be rom.
pleted In six months.)
NOTE: Applicant Sijbicct to Plan Check Fee
Thin Permit covers work to be done on private Property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
INSPECTION
DEPARTMENT
CITY OF
EDDIONDS
rR 6-1107
0 YES 0 NO
Valuation I Fee
KEA
I
0
I
No.
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.
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