680340.pdf-TO'BTEDON KROLL MAP NO.: PERMIT
NUMBER 6BD340
BUILDING DEPARTMENT A p pu 7c:m t n2 a JZ 0
PR�j! Inside HeaVy Linum JOB ADDRESS
ERMIT APPLICATION
NAME (OR NAME OF B SINESS)
SIDE YARD SETBACK STREET SETBAG AR YARD SETBACK
A c Pal Ar 19 C, it
FMA�ILING ADDRESS 17
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LEPHONE NUI
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IMBER
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CITY LICENSE I
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ProDertv tshow Below or Attach Four C
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[UMBER A4
STREET_W/W
EXISTING STREET R/W .61�FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W .4?Z�FT- .... 9..FT.
REMARKS
NEW
RESIDENTIAL
GAS
LINE
El
NO
0
SIGN
RETAINING
---
1:1 DEMOLISH
WALL
ElALTER EXCAVATE
E]
FENCE
Ft.)
OR FILL
( .......... x .........
REPAIR PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF ETORIE13
I NUMBER OF
DWELLING
UNITS
NATURE OF
P, r, tv
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7
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-
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
C
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on Private property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways,
marquees, ate.) will require separate Permission.
i — fed o -Siandard Drawing #103.
ndica n
5 'it i.,
Mr
[] YES WO
Fee
Plan Check No ........
BUILDING
PLUMBING
HE AT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
[in I'To
TOTAL AMOUNT DUE
:3 5. 0
(/�S-S-cf
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building official or his Dep-
ONLY THE
11VORK. NOTED
uty; and fees are paid, and receipt is ac-
lmowledged in space provided.
INSPECTION
S
DIRECTOR'S SIGPI, TUR
IRECT
DEPARTMENT
�
IDATE
CITY OF
EDIVIONDS
PR 6-1107
FILE