680484.pdfPOSTED 014 IMOLL MAP No.;
BUILDING DEPARTMENT
Applicant FIR
PERMIT APPLICATION Inside Ileavy Lines JOB ADDRE1113 7--Z77
or
oi�' 7,,
Q
NEW
ADD
ALTE R
E-1 REPAIR
RESIDENTIAL
NON-RESIDENTIAL
F1
F1
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( .......... x . ........ Ft.)
swim
POOL
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
INSP.
rUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
PERMIT
NUMBER
T4
VACANT SITE
[3 YES E3 NO
VARIANCE NUMBER 1;4
EXISTING STREET R/W ........... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. RAV ........... 11T. ............ VT.
TYPE, OF
[I YES [3 NO
Plan check No .....................
-PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
99
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIM NG 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 Is correct: and that I am the owner, or the duly author -
Iced agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Elate of Washington
THIS PERMIT
relating to WorkmeWs Compensation Insurance.
AUTIIOIUZES
NOTE: Permit Limit One Year (Except DE1,11OLITIONS which
ONLY TjtE
WORK NOTED
shall be completed In ninety days; MOVED -IN DUELDINGS shall be com.
plated in six months.)
HIGNATMq (OW OR AG ATL SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
NOTE: Applicant Silbject fol"Plan Check Fee
Pit 6-1107
This Fern -at covers work to be dorz on privets property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission -
BY
[I YES [3 NO
Fee
Q
;f;
W
No.
I -Y - C Z H411
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.
PIZ av
I
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