690426.pdfI
Z
ILDING DEPARTMENT Applicant Fill
Inside Heavy Lines —joBAD]
PERMIT APPLICATION
M��Vu AUV�00
"I IT
ADDRESS
7
T
STATE LICENSE
_:� _7:3 lc> A
L
W IV
or
�-777
NEW
RESIDENTIAL
I
,-,
GAS
LINE
NON-RESIDENTIAL
F
SIGN
ADD
RETAINING
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
FENCE
( �x Ft.)
......... ..........
REPAIR
PRE -MOVE
INSP.
swim
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
'/- L) M / A/-
SROLL KAP NO.: PERMIT
NUMBER
0 1
EXISTING STREET R/W ........... YT
COUP. PLAN ST. R/W ........... XT
FIRE ZONE I TYPE OF
0 YES El NO
Plan Check No ............ . .......
BUILDING
PLUMBING JJ 6),
HEAT & GAS LINE
FENCE
SIGN
I
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
[3 YES
13 NO
DEFICIENCY THIS PROPERTY
STREET IMPROVI
[] YES [] NO
Fee
Ra
Ad
Z
I
No.
TOTAL AMOUNT DUE
AMOU...
/ZV
I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I ELM the owner, or the duly Author-
lzed Agent of the owner. I agree to comply with city and state lawn rcgu-
APPLICATION APPROVAL
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
rAITMNTION
THIS PERBUT
This application is not a permit until
relating to Workmen's Compensation Innurance.
AUTHORIZES
n
signed by the Building Official or his Dep-
NOTE: Permit Limit Ono Year (Except DEMOLITIONS which
ONLY THE
I
WORK NOTED
uty; and fees are paid, and receipt is ac-
"hal b completed In ninety days; MOVED -IN BUILDINGS shall be com.
lmowledged in space provided.
PIZ � at)Cmonths.)
III URE (OWNEI 0
INSPECTION
—M—RECTOR'S 1
DEPARTMENT
CITY OF
DATA
EDDIONDS
'ect to Plan Check Fee
NOA: APP cat Stj
PR 6-1107
This Permit envers work to be done an Private Property ONLY.
Any construction on the pablic domain (curb#, sidewalks, drivawAys,
marquees, etc.) will require separate Permission.
: I