680533.pdf0
BUILDING DEPARTMENT
PERMIT APPLICATION
NAMM (OR NAME OF BUSINESS)
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MAILING ADDRESS'
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NAME
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POSTED ON KROLL MAP NO-: PERMIT
ApplIcant Fill //< � , I NUMBER
Inside Heavy Lines JOB ADDRESS
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SIDE YARD SET STREET SETBACK
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NEW
RESIDENTIAL
LINE
NON-RESIDENTL4,L
El
SIGN
Li
RETAINING
WALL
DEMOLISH
EXCAVATE
FENCE
ALTER
D
OR FILL
( x Ft.)
REPAIR
1:1
PRE -MOVE
INSP.
D
........ . ..........
SWIM
POOL
tUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
680533
-S-1 1274��. . 0
A.NT SITE
MS NO
E NUMBER ;6
9TREB"/W
EXISTING STREET R/W S. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W .5-0.-rr. ...
REMARKS
Drivewav slopes not to exceed those
indicated on Standard Drawing 0103.
�BMARKS
[3 YES
plan Check No .................
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
'71. 5� 59
BEAT & GAS LINE
FENCE
t
SIGN
N
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 regu-
ATTM4TION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation or the Labor Coda of the State of Washington
THIS PERMIT
relating to Workmeu-s Compensation Insurance.
AUTHORIZES
NOTE: Permit Umit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed to ninety days; MOVED -IN BUILDINGS shell be oom-
pleted In mix months.)
UONATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
&I
DEPARTMENT
CITY OF
EDDIONDS
NOTE: Applicant Subject to Plan Cbeck Fee
PR 8-1107
This permit coven work to be done on private property ONLY.
Any construction an the public doman (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
1 [3 YES 13 I -TO
IROUP
No.
Ar, S-0
140.4 "
APPLICATION APPROVAL
This application is not a permit until
eigned by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged In space provided.
MIM1290
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