690133.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
Cd
41
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Applicant F111
Inside Heavy Lines
- 4, r �-- 4.
U-NEW EI�SIDENTIAL
GAS
LINE
1:1 NON-RESIDENTLAL
ADD
SIGN
RETAINING
WALL
DEMOLISH
ALTER EXCAVATE
OR FILL
FENCE
( x Ft.)
........ . ..........
REPAIR PRE -MOVE
INSP.
swim
POOL
M
NUMBER 0if
DWELLING
UNITS
C2
TATURE OF WOR TO BE DONE
V eel 4-
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4914 , t4 W 4vc-'?
I hereby acknowledge that I have read thM application; that the in-
formation given lit 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-
lating construction; and in doing the work authorized thereby, no person
w1I1 be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shalt be completed in ninety days; MOVED -IN BUILDINGS shall be Com-
pleted in six months.)
( I I U J 1--r-11 f. t
tl� 3-le
NOTE: Applicant Subject to Plan Cbeck Fee
This pem-At coven work to be done on private property ONLY.
Any construction on the publio domain (curts. sidewalks, driveways,
marquees. etc.) witt require separate perwilaBlon.
11
ON KROLL MAP NO
- /02 o 0 .
kESS
13 All — FC/
,RD SETBACK STREET I
( M - AL(
1P__J
. NE LOT ARE
V I -.;kl I
MKA�M& a./"
EXISTING STREET R/W .32..FT-
COUP. PLAN ST. RIWb- JrT.
PERMIT
NUMBER
690133
ETBACK
REJUI YARD SETBACK
CANT 8 rE
)6EB 13 NO
AREAL
f VARIANCE NUM"AUS CW
DEFICIENCY THIS PROPERTY
indicated on Standard Deawing #103.
It
pwi;'
0 YES %Z NO
REMARKS
Plan Check No....
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
AT=NTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
PH 0-1107
[3 NO
Fee
No.
It 3.601"" 1 N Tial
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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