690265.pdfPOSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Appllcant FIU
14UM13ER
Ileavy Lines
PERMIT APPLICATiON it
JOB ADDRESS
NAME (OR NAME OF BUSINESS)
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SIDE YARD SETBACK
STREET SETBACK
REA.R YARD SETBACK
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LOT AREA
VACANT SITE
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BUILDING AREA
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ADDRESS
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D'�NEW
Er RESIDENTIAL
GAS
LINE
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NON-RESIDENTIAL
SIGN
RETAINING
F]
DEMOLISH
WALL
EXCAVATE
FENCE
ALTER
OR FILL
( x Ft.)
0 REPAIR
PRE -MOVE
INSP.
.......... ..........
SWIM
POOL
IM13ER OF
DWELLING
UNITS
V
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
IPW4*01
0 YES [] NO
Plan Check No ............. .......
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I 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-
0
Ized agent of the owner. I agree to comply with city and state laws regu-
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ATTENTION
lating construction; and In doing the work authorized thereby, no pcnon
Is
will be employed In violation of the Labor Code of the State of Washington
wl
THIS PERMIT
relating to Workmen's compensation Insurance.
AUTHORIZES
N OTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOV;&D-IN BUILDINGS shall be com-
pleted In six months.)
S 11 _ G
LGNATURr (OWNER WAGENT) DATE SIGNED
INSPECTION
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DEPARTMENT
CITY OF
jo —7
EDDIONDS
NOTE: Applicant Subject to PlanCheck Fee
PIL 6.1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways,
mmquees, etc.) will require separate permission.
DEFICIENCY THIS PROPERTY
............ F.T.
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W
STREET IMPROVED
[] YES [] No
— a4_ 1, To
Valuation I Fee I Receipt No.
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-
knowledged in space provided.
DIRrCTOR'8 SIGNATURE
DATE
1�7 - / () -6 '9
FILE