680380.pdfj
BUILDI,NG
DEPARTMENT
Applicant M
PERMIT APPLICATION
inside lacavy Lines
N
NAME (OR N 10 OF BUSINESS) r
1�_37�4a
Z
:a
MAILING ADDRESS
V 0 Of
0
CITY TI;LEPHONE NUM13ER
NAME
ADDRESS
CITY
TELEPHONE NUMBER
NAM
1_71e 6� 4,99
ADDRESS
_r 7�4L,
2,4 Z
CITY
TELEPHONE NUMBER
'.7 C- C7
/_ X4. C?, V V -I
STATE LICENSE NUMBER
CITY LICENSE NUMBER
'Legal Description of Property (Show Below or Attach Four Copies)
Z
0
NEW
RESIDENTIA
GAS
LINE
ADE�
NON-RESIDIR TIAL
r SIGN
Z
ALTER
n
DEMOLISH
EXCAVATE
OR FILL
RETAINI
WALL
PENCE
( ........ x .......... Ft.)
REPAIR
11
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
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 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 WorkmenIn Compensation Insurance.
NOTE: Permit Limit One Year (Except DE51OLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be core-
pleted In six months.)
310 R OR AGENT) DATE SIGNED
14-4,6 1 amr/6v
FO-STEDON KROLL MAP NO.: PERMIT
NUMBER
JOB ADDRESS
C4
E31DE YARD SETBACK STREET SETBACK REAR YARD SETBACK
IdBE _ZONE LOT AREA VACANT SITE
_1 0 YES 0 NO
HEIGHT BUILDING AREA VARIANCE NUMBER
PLOT PLAN APPROVED
STREET H1W
EXISTING STREET R/W ........... XT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ........... XT. ........ ... ITT.
REMARKS
CHECKED BY
METER SIZE I SERVIC 1Z CLEARANCE CHECKED BY
REMARKS
TYPE CONNECTION VERIFIED BY
PERO. TEST PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
I 1 1`1 YES J-1 NO
[] YES
PLAN C]
[] NO
D BY
rtan Check No ............ . .......
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWI NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
P6 co, - =
NOTE: Applicant Subjcct to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
nuunueeg, ate.) will require separate pennisslon.
D OCCUPANCY GROUP
Valuation
Fee
0e.,
le
Z
R
14
No.
TOTAL AMOUNT DUE
ATMNTION
APPLICATION APPROVAL
THIS PERMOIT
This application is not a permit until
AUTHORIZES
Signed by the Building Official or his Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION
DIRECTOR'S SIGNATURE
DEPARTMENT
CITY OF
EDIVIONDS
DATE
PR 6-1107
FILE
N
I
i
Al.