700054.pdf. .
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BUILDING DEPARTMENT Applicant Irill
PERMIT APPLI( Inside Heavy Lines 7
1771
�� 0-7Z
NEW RESIDENTIAL
GAS
LINN
NON-RESIDENTIAL
SIGN
D---
DEMOLISH
RETAINING
WALL
ALTER
r�
EXCAVATE
OR FILL
FENCE
( x Ft.)
REPAIR
PRE -MOVE
INSP.
........ . . ........
SWIM
POOL
DWELLING
UNITS I
4:7-eo a 0 - 70
EXISTING STREET R/W ............ FT.
COUP. PLAN ST. R/W ........... XT.
PERMIT -700054
NUMBER I
[3 YES 13 NO
DEFICIENCY THIS PROPERTY
BY
FIRE ZONE TYPE OF CONSTRUCTION I STREET IMPROVED
[I YES [j NO
SPECIAL INSPECTOR REQUIRED
F] YES [] NO
OCCUPANCY GROUP
PLAN CHECKED BY
REMARKS
'B A:z & — -2 0 0 0 0-1
Plan Check No ........
BUILDING
PLLTKKNe�/q :94.—
HEAT & GAS LINE
FENCE
SIGN
tRETAINING
N
WALL
I
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
AMOUNT DUE
—1—TOWAL
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 lawn regu-
lating construction; and In doing the woric authorized thereby, no person
will be employedju violation of the Labor Code of the State of Washington
relating to Workmens Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In mix months.)
'Z�/6 �70
NOTE: Applicant Sub a to Plan Check Fee
This Permit covers work to be Cone on Private property ONLY.
Any construction on the public domain (curbs, SideWrAkS, drIVOWSYS,
cnarquees, eta.) will require separate Permisslou.
0=0
Fee
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or Ids Dep-
ONLY TIM
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION —DLRECTOR'll %SIGNATURE
DEPARTMENT
CITY OF
EDIVIONDS
PE 6-1107
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