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BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
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Applicant Fill
Inside Heavy Lines
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ADDRESS
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'E LICENSE NOME
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NEW
19 RESIDENTIAL
VI
GAS
LI N I,
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NON-RESIDENTrAL
SIGN
ADD
RETAINING
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
PENCE
( X Ft.)
... ...... ..........
REPAIR
PRE-31OVE
INSP.
swim
POOL
ITUMBER OF STORIES
NUMBER OF
DWEY�LING
UNITS
A 0 1�
IDE 7ARD SZT�S,
r13 0 rA 1�v
�P NO.: PERMIT
6'80437
NUMBER
4UeA_-
—BACK
13TREET SETBACK HEAR Y SET
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0 _ , /V) A^�
LOT AREA VAU" K SITE
14"
I [] YES )40
BUILDING AREA VARIANCE,
__ __ — - I - -
EXISTING STREET R/W --FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... ST. ........... 1"T.
TYPE OF
[] YES -% NO
PLAN CHECKED 13Y
Plan Check No .....................
PROPOSED USE
BUILDING
Q
1�
Q PLOT PLAN (Indicate Building setbacks utting streets)
PLUMBING
22
BEAT & GAS LINE
FENCE
t
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 lawn regu-
ATTENTION
latIng construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Waishington
TIUS PERMIT
relating to Workmens Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed in ninety days; JAOVED-ILN BUILDINGS shall be eom-
pleted In six months.)
_81_G_1_1`A1J_1RtE _�(OWNER OR AGENT) DATE SIGNED
INSPECTION
12
EPARTMENT
i�n�
CITY OF
EDIVIONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
YES [3 No
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X
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Fee Receipt No.
YVI
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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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