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BUILDING DEPARTMENT
PERMIT APPLICATION
ADDRESS
CITY
Q
STATE LICENSE NUMBER
S �?_S - 6) - 'YjS
Lega.1 DescriptLon of Property
FA
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Applicant FIB
Inside Heavy Lines
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WHONE NXJ
(A. —6 —
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W I GAS
NEW RESIDENTIAL F1 LINE
rED NON-RESIDENTIAL I EJ SIGN
ADD RETAINING
DEMOLISH WALL
ALTER EXCAVATE PENCE
OR FILL ( .......... X .......... Ft.)
REPAIR PRE -MOVE swim
INSP. POOL
NUMBER OF
DWELLING
UMTS —<I
!AXTURE OF WORK TO BE DONE I
Wif A Y , Y;7.� < J*-, ��A A�7 o�
0
!D ON KROLL MAP NO.: PERMIT
ER
JNUMAiZ68015 10
DDRESS
' ;9L
TA_RD_ SETBACK STREET SETBACK REAR YARD sETBj
ZONE LOT AREA VACANT SITE
0 NO
'0
KISTING STREET R/W..2 ........ M. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/;v,5..0..FT. ..0 .... . FT.
indicated on Standard Drawing #103.
I t
0 YES
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
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 laws rogu- ATTENTION
re
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 THIS PEII511T
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
N TE: Permit Limit One Yekir (Except DE31OLITIONS which WORK NOTED
El, I be compl5cd-Ju-misisty days; MOVED -IN BUILDINGS shall be com-
13 t in six Aonths.)
NOTE: Applicant Subject to Plats Check Fee
This Permit covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
rmurquees, etc.) will require separate permission.
INSPECTION
DEPARTMENT
CITY OF
EDDIONDS
PR 0.1101
[] YES 0-40�
Fee
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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 s.c-
knowledged in space provided.
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