690184.pdfBUILDING DEPARTMENT Applicant Fill
Inside Heavy Lines
PERMIT APPLICATION
INAME (OR NAME OF BUSINESS)
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MAILING ADDRE85
CITY TELEPHON15 NUMBET
JC7 /./ /-- Z/ ,-f - /� 7- 13
ADDRESS
CITY
1—UMBER
cY _:� 70
1
Legal Description Of Property (Show Below or Attach Fou—rcoides)
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/4 4)
NEW Rk:SIDENTIAL
GAB
LINE
I NON-RESIDENTIAL
SIGN
ADD
RETAINING
WALL
DEMOLISH
ALTER EXCAVATE
FENCE
x Ft.)
OR FILL
( ........ . . ........
E] REPAIR PRE -MOVE
INSP.
SWIM
POOL
NUMB OF STORIES
T37
NUMBER OF
DWELLING
UNITS
z
n.
PROPOSED USE
PLOT PLAN (Indicate Building setbacks. abU
DL t
flIA-e- N
N
I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owmer, 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
will 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
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: APPlicant Subject to Plan Check- Fee
This remit cove" work to be done on private property ONLY.
Any construction on the public domain (carbs, sidewalks, drIVOWSYS,
marquees, etc.) will require separate permission-
N YRU" MAP DIU.; PET -MIT
// 5— NUMBER 6%
D SETBACK REJUL X.
LuT AREA ANT
q i I WYES
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JBA
[3 NO
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UMBF
EXISTING STREET R/W 5 YT- DEFICIENCY THI13 PROPERTY
COMP. PLAN ST. RIWS.-!�-XT- ... 0 .... FT.
indicated oj� —Standard Drawing #103.
-14 X
_J I(
rYPE CONNECTION
E-ERC. TEST
REMARKS
FIRE ZONE TYPE OF
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SPLACL%.L INSP CTOR
[3 YES 01)0
A)V 4;Af.4CK1_ 40/7,
45A.) _r4f-5 Fer�—" /
Valuation
Plan. Check No ........
0 YES 0 rTo
Fee
BUILDING
F/
PLUMBING ka
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIL13UNG POOL
OLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
TIUS PERMIT
This application Is not a permit until
AUTHORIZES
Signed by the Building Official or his Dep-
ONLY TIM
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged In space provided.
INSPECTION
DIRECTOR'S 8 AT
DEPARTMENT
:I;6�
CITY OF
D
EDDIONDS
PR 6-1107