700057.pdf5
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POSTED bN_ KROLL MAP NO.: pEnMIT -7
NUMBER 100057
BUILDING DEPARTMENT App711ca=n.t FlU 19
11
PERMIT APPLICATION Inside Heavy Lines jug ADDRpss 0
I NATE (OR NAME OF BUSINESS) ar 77��4 ell"
'ET -SETBACK I RUEAR Y RD BE: ACK
RU SUfIJACK I 8TRE
SIDE YA
2
CITY
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7
or
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NEW
[;V] RESIDENTIAL
I
El
GAS
LINE
n
NON-RESIDENTIAL
EJ
SIGN
0 ADD
RETAINING
ElDEMOLISH
WALL
ALTER
n
EXCAVATE
OR FILL
FENCE
( x Ft.)
.......... ..........
REPAIR
PRE -MOVE
INSP.
El
swim
POOL
NUMBER OF
DWELLING
UNITS
EXISTING STREET R/W ............ FT.
comp. PLAN ST. R/W ............ IrT.
TYPE
C] YES *90_�
REMARKS
b%� orf L
Plan Check No .....................
BUILDING
61
/0
PLUMBING
'Cr
—PLOTPIE-4
�N(IndlCate BUIR11#9 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-
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-
ATTENTION
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 PER.11IT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
SIGNATURE (OWNER Olt AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDDIONDS
NCITZ. 'Applicant Subject to Plan Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction n the public domain (curbs, sidewalks, driveways,
marquec:, etc.) will require sepamte Permission.
[3 YES (3 NO
BY
THIS PROPERTY
0 YES
valuation I Fee
APPLICATION APPROVAL
No.
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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