680329.pdf-----
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IT
-708—TED
ON KROLL MAP NO.:
n I I n I U r-b n C D A 0 T C H T
I i '!z r_-
INUMBER 680329
W Applicant 10111
PERMIT APPLICATION inside Heavy Lines
NA?.tm (OR NAME OF BUSINESS)
G 50RC7,6F J-
9- 311— 6 S..F. Apl' 17
CITY 11 'TELEPHONE NUMBIIIR
o nds PR 6 - q 3 6
NAME
0 VV% b, S ?e rr- 9
7/ 1 q,2, Pf, 5. W.
CITY TELEPHONE NUMBER
L�YAAIWOOP tv4stf
NAME
8 r Li
ADDRESS
3.50 9 —
.A.A ;?- , ej^'.2' Uj
3217rBACK STREET SETBACK REAR, x
7.
AREA VACANT
I �dYES
%/W
; STREET R/W X� .. XT-
PLAN ST. R/W..J:::2 ... FT.
I
BMW tllU�ENHN NULM'8;�
01 a�) —0
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Legal Description roperty (Show, Below
or Attach Your copies)
L-0-T / 6)
A-b h I Q41-1 Y
V1 E!��_
RECORbe.P
1AJ V01--
er
W,4S01Aj6)T_6Aj
RESIDENTIAL
M GAS
LINE
I
E] NON-RESIDENTIAL F-1 BIG,,
DDEMOLISH
RETAINING
WALL
ALTER
EXCAVATE
n OR FILL
FENCE
( Ft.)
........ _x ..........
D REPAIR
PRE -MOVE
1:1 INSP.
swim
POOL
ES_
NUMBER OF
DWELLING
UNITS
Ica
SIZE SERVICE
it 1 .3,/4 1(
E] YES
T-) LW
Plan Check No ............ . .......
USE
BUILDING
N (indicate Building setbacks tting streets) FLUM13ING
jej.
HEAT & GAS LINE
r
CIA
FENCE
T�
t
SIGN
N
RETAINING WALL
SWIMMING POOL
r4
OLITION
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
lating construcUon; and in doing the work authorized thereby, no person
be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
will
relating to WorkmerVe Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed In ninety days; DIOVED-IN BUILDINGS shall be com-
pleted In six months.)
INSPECTION
SIOPATURE (OWINJUn Ult �54z"K DATE SIGNED
DEPARTMENT
CITY OF
EDIVIONDS
NOTE: Applicant Subject to Plan Chcck Fce
Pit 0-1107
This p Xmit coven work to be done oe private property ONLY -
Any construction on the public domain (curb@, sidewalks, driveways,
marquess, etc.) will require separate permission.
3
13 NO
[UMBER ow
DEFICIENCY THIS PROPERTY
(—I
In
PROVED
13 YES
Valuation Fee -Receipt No.
1/3/,0611
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-
lmowledged in space provided.
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