690413.pdf1 BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME %OR AME OF BUSINESS)
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W MAILING ADDRESS
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�" "20,707 '5i>D't' k,,/
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or
PER1dIT
,D ON KROLL MAP NO.: NUMBER
�ARD SETBACK
STREET SETBACK
nEAR YARD
�ONE
LOT AJUIA
VACANT SIT,
YES
6,0
KISTIlM STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ....... ... XT. ............ . FT.
GAS 0 YES
KNEW RESIDENTIAL LINE PLAN
1 1:1 NON-RESIDENTIAL SIGN
0 RETAINING REJ
DEMOLISH El WALL
ElALTER EXCAVATE FENCE
0 OR MLL ( ......... �x . ........
REPAIR 1 PRE -MOVE swim
1:1 INSP. POOL
;UMBER OF STORIES NUMBER OF
DWELLING
UNITS A/6 KSL.
k-:l CL Y-!��
Plan Check No ................ . ...
e,
PAhJ rs 0n:r:2n9___
BUILDING
D USE
47
PLUMBING
U4 (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
4OT LeAott,= 7-2:2'
N
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the in-
formation given to 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
will be employed In violation of the Labor Coda 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.)
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NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require oeparate permission.
TOTAL AMOUNT DUE
ATTE NTION
Tlus rERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDDIONDS
PR 6.1101
STREET IMPROVEr
0 YES
NOY GROUP
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Fee
a
Z
04
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
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