700021.pdfBUILDING DEPARTMENT Applicant Fill
Inside Ifeavy IlAncs
PERMIT APPLICATION
NAME (OR NAN LE OF BUSINESS)
Niel
4
MAILING ADDRESS
j
0 CITY
E PH NE NUMBER
LE 0,
TFr
9V7
NAME
ON KROLL MAP NO.: PERMI
0(
HESS
LRD SETBACK STREET SETBACK
I I I
INE LOT AREA
—7.0 1 CJYES
BUILDING AREA VARIA
24 ADDRESS zzx cze;�= 10
406 MM14 �T STRERIVB/W
CITY 'TELEPHONE NUM13ER EXISTING STREET R/W ............ FT -
COMP. PLAN ST.
REMARKS _EIW ... ..... XT-
0
NAME
CITY TELEFTONE �NUMBER
A METER SIZE
STATE LICENSE NUMBER CITY ICENSE NUMBER
Legal . Description of Property (Show Below or At h Four Copies) REMARKS
L-4 V6f Edyk (1� to Unvok TYPE CONNECTION
PERC. TEST
REMARKS
V TYPE OF CONST.
:13
EXT
F� GA C] YES 0
F� NEW RESIDENTIAL LINE PLAN CHECKE BY
NON-ItESIDENTIAL SIGN
AD" RETAINING REMARKS
DEMOLISH WALL
.0 ALTER EXCAVATE FENCE
OR FILL ( .......... x . ........ Ft.)
PRE'MOVE SWIM
REPAIR INSP. Ej POOL
WF STORIES NUMBER Gir
DWELLING �L I
T UNITS 7
NATURE OF WOYU�__TO 13E DONE -
;ddt*0it 0� 7 5*� Plan Check No ............ ... ....
4 ex4lm bNOl'!1 BUILDING
[FROPOSED USE PLUMBING
HEAT & GAS LINE
PLOT PLAN (Indl to Building setbacks, abutting streets)
r
FENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the in.
formation given is 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; nod In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
relating to Workmea'd Compensation Insuraw7a.
NOTE: Pe rmit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
ENT) DATE SIGNED
A 7110161
NOTE: ApplicaW Snbject to Plan Check Fee
This permit covers work to be done on private property ONLY.
Any construct[ a on the public domain (curbs, sidewalks, drlvaw%Ys,
0 separate permIsslon.
Marquees, etc.) will require
TOTAL AMOUNT DUE
AT=NTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDDIONDS
PH 6-1107
IN&
110,414'e- ya�
DEFICIENCY THIS PROPERTY
0
� Al 10 YES 0 No
Fee
MM-Wi
M
i
Z
I
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.
— �Oj— 7 oD
Film
Y 11.,
r) �h,*Ajb
J C.
-DEPARTMENT cant Flu
BUILDING, AtI App" ,
PERMIT APPLIC ON inside Heavy Lines
NAZE (OR NAME OF BUSINESS)
- ]UILING �"DRESS
CITY 'Xz�MONE NUMBER
i� ; ",/ I -q,7
NAME
W ADDRESS
CITY IELEPHONE NUMBER
I- �-�!mpj P�, 11, 6 1 -�' -15-
:9
OSTED ON KROLL MAP NO.:
PERMIT
NUMBEIr
5—D ADDRESS
-5
L G
442 A Q
I - IDE YARD SETBACK STREET SETBACK
-RE AR YARD SET
/ I
5
1*7 j
USE ZONE T AREA
VACANT SITE
o
YES 0
�NUAWER
TE—IGHT BUILDIN A1SZA
v - AnIANCE 04
PLOT PLAN APPROVED
�-v
/0 6-
,,
It Vt
d,
1p; i,
.4:�2
STREL-r R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ....... .... FT.
... ........ IV.
0
REMARKS
TWY
I i I UCIKffED
REMARKS
egal Description of Property (Show Below or Attach Four Copies)
PP.11MTM WTTAITIER
f) VERLFlEI> 13Y
TYPE CONNECTION
RESIDENT11 LL
AS
LINE
EJ
NEW
WON -RESIDENTIAL
SIGN
RETAINING
WALL
DEMOLISH
ALTER
F
EXCAVATE
PENCE
OR FILL
......... X .......... Ft.)
REPAIR
PRE -MOVE
INSP.
swim
Pool.
NUMBER Or STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WOITC TO BE DONE
—fE—MARKS
FIRE ZONE
0 YES
/V I [] YES
:CTOR REQUIRED OCCUFANCYGROUP
O�NO
3 BY
PROVED,
No
Fee Receipt No.
I �
Plan Check No..� .... . ..........
BUILDING
0
PROF6SED ; U13E
PLUMBING
PLOT P LAN (Indicate Building setbacks, abutting streets)
HEAT dc GAS LINE
FENCE
SIGN
t
RETAINING WALL
N
SWIMMING POOL
L.
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In
formation given is 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.
A17TENTION
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
THIS PER511T
This application is not a permit until
relating to Workmen's Compensation insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOT E: Permit Limit one Year (Except DEIMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVEDAN BUILDINGS shall be com.
knowledged in space provided.
pleted in six months.)
SIG�ATUTJ7P —(01,YNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
DIRLCTOR'S SIGNATURE
CITY OF
I
EDAIONDS
D ATE
NOTE: Applicani Subject to Plan Check Fee
Pit 0-1107
TWO Permit covers work to be done on private property ONLY.
An, construction an the public domain (curbs, sidewalks, driveways,
INSPECTOR
marquees, etc.) will require separate permission.