680345.pdfW
POSTED ON KROLL MAP NO.:
BUILDING DEPARTMENT
Applicant Fill
PERMIT APPLICATION Inside Heavy Lines JOB ADDRE138
NAME (OR NAME OF BUSINESS)
—SIDE YARD SETBACK STRE
C4 MAL G ADDRESB LOT
PERMIT
NUMBER 680345
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USE ZONE 0 YES NO
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NAME
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DRESS
TELEPHONE NUMB�
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CITY
TELEPHONE NUMBER
—LICENSE
STATE LICENSE NUMBER
_UITY NUMBER
Legal Description of Property (Show Below or Attach Four Mp—,,;)�
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�GAS
RESIDENTIAL LINE
NEW
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E] NON-RESIDENTIAL JF� 13IG14
F� RETAINING
F� DEMOLISH WALL
ALTER EXCAVATE FENCE
ROR FULL (A�S._x ... ..... Ft.)
F_1 PRE -MOVE SWIM
REPAIR INSP. POOL
DWELLING
UNITS
NATURE OF WORK TO BE DONE
11J.5 -Z4�61L� -5 &,� t �-Yh-1 / PJ PO 6
PLOT PLAN APPROVED
STREET AIW
EXISTING STREET R/W ... ........ FT- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W .......... FT. ....... .... IrT.
REMARKS
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I hereby acknowledge that I have read thin application; that the In-
formation given in 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-
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 Umit One Year (Except DENIOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In mix months.)
ijanvpaii; mFNER OR AGENT) I DATE SIGNE13
NOTE: Applicant Snbject to Plan Check Fee
Thin Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs. slidewalkno drivewayso
marquees, ate.) will require separate permission.
CHECKED BY
M
T7.V*T1W-
PE CONNECTION VERIFIED BI
RC. TEST PERMIT NUE
MARKS
EtE ZONE TYPE OF CONSTRUCTION
10 YES [3 No
OCCUPANCY GROUP
0 YES [3 NO
PLAN CHECKED BY
Plan Check No ........
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
AT=NTION
TICIS PERMIT
AUTHOIUZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDAIONDS
rn 0-1107
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Valuation I Fee I Receipt No.
RM
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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.
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