690025.pdfF, 1.
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BUILDING DEPARTMENT Applicant M
PERMIT APPLICATION Inside Heavy 'Anes
NAME (OR NAME OF BUSINESS)
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690025
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IT SITE
NO
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TELEPHONE NUMBER
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EXISTING STREET R/W,$-.!R.FT.
COMP. PLAN ST. R/W.40a.-FT.
DEFICIENCY THIS PROPERTY
REMARKS
Driveway slopes not to
exceed
those
Nt.-T [y),Q s
'S
indicated on Standard Drawing
#103.
CHECKED BY
7U mB E
TELEPHONE NUMBER
1.
METEHSIZE I SERVICE SIZE CLEARANCE
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CfTY LICE quE Vuwujun
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Property (Show Below or Attach your Copies)
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TYPELCONNECTION
VE:;�DT
-7
0 YES [j NO
Eg--N�Evw
RESIDENTIAL
L161 LINE
ENTIAL
SIGN
17 ADD
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
FENCE
I
OR FILL
( ........ .
REPAIR
PRE -MOVE
INSP.
swim
POOL
NUMBER OF STORIENS
_INUMBWA OF
00)
DWELLING
UNITS
Plan Check
PROPOSED USE
.-
BUILDING
PLTJMH[NG
MOT PLAN(Indl Building setbacks, abutting streets)
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 �if 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 State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY T=
NOTE: Permit Limit One Yeur (Except DEBIOUTIONS which
WORK NOTED
shall be completed In ninety days: MOVED -IN BUILDINGS zball be com-
pleted In six months.)
TORE (OWNE Ult A zi"A)
E SIGNED
INSPECTION
ID
DEPARTMENT
316
CITY OF
EDDIONDS
NOTE: Applicant Subject to Plan Check Fee
PH 6-1107
This Permu coven work to be done an private property ONLY.
Any construction an the Public domain (curbs, sidewalks, driveways,
Courqueeg, etc.) wul require separate permission.
El YES 13 NO
cc
I
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Valuation Fee Receipt No.
APPLICATION APPROVAL
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac
This application is not a pern*dt until
Imowledged in space pr ovIded-
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