690281.pdf104
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BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Ilcavy Lines
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ADDRESS
_Z
CITY TELEPHONE NUMBER
6 � 11fi
Sl / 141- 111_7�610
MAP NO.: PERMIT
NUMBER
Agn?8 i
V_ ez4-
CK STREFT SETBACK HEAR YARD BET13ACIC
'1% :R,5 I ti - � as I M I t
LOT AREA !-VACANT IJITE
[j YES 51"�NO 4
VARIANCE NUMBER N
EXISTING STREET H/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. RAV ............ FT. ............ FT.
0
Z
W
a
bIAUN WUNNUM NUAIIU�l
UIWY LLCEN&W; NUMBER
REMARXS
Legal Description of Property (Show Below or Attach Four Copies)
3
TYPE CONNECTION
VERIFIED BY4
ZZ
PERC. TEST
PERMIT NUMBER
REMARKS
O.K. to connect into sanitary sewers,
Ut with no larger line than 211.
FIRE Zq�b� 11-YFE OF CONSTRUCTION STREET IMPROV D
�1
0 0
%Ad d _% I �L� 900�s 13 I'T
ElNEW
DADD
ElALTER
REPAIR
RESIDENTIAL
if NON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
INSP.
GAS
LINE
SIGN
RETAINING
WALL
PENCE
( .......... x .......... Vt.)
swim
POOL
[:] YES
PLAN CHI
M/
REMXT
NUMBER or
DWELLING
UNITS
0o, '"� S Plan Check No .....................
BUILDING
IOSED USE
PLUMBING
PLAN (Indicate Building setbacks, abutting streets) HEAT & GAS LINE
FENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
th a In -
au
formation given Is correct: and thL%t I am the owner, or the duly author.
'h or'
w
Ized agent of the owner. I agree to comply with city and state laws regu-
r gu-
ATTENTION
lating construction; and In doing the work authorized thereby, no person
0 person
'shla gton
will be employed In violation of the Labor Code of the State of Washington
THIS IIER311T
relating to Workmen's Compensation Insurance.
AUTHORIZES
V,.
NOTE: Permit Limit One Year (Except DEIMOLITIONS which
ONLY THE
WORIE NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted Ii six months.)
H—GNZARL (OWNE NT) DATE SIGNED
INSPECTION
1,0A.
e
DEPARTMENT
CITY OF
EDDIONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalka. driveways,
nja�rqjjers, ete.) will require sej=ate permission.
Valuation
M640
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.
FILE
IA-7&