700123.pdfBUILDING DEPARTMENT Appllcant Flu
PERMIT APPLICATION IRsIdo licavy Lines
NAME (OR
'44AME OF BUSINESS)
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fr-6761
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ADDRESS
cd CITY TELEPHONE NUMBER
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NAME
ADDRESS
CITY TELEPHONE NUMBER
f Property (Snow Below or Attacn Four Coples)
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NEW
RESIDENTIAL
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GAS
LINE
DADD
El
NON-RESIDENTIAII
SIGN
RETAINING
EJDEMOLISH
WALL
EXCAVATE
FENCE
ALTER
R
OR FILL
(.//0._xA/ rt.)
REPAIR
1:1
PRE -MOVE
INSP.
El
SWIM
POOL
NUM13ER OF
DWELLING
UNITS
e2 -4, f a 'd5' 'f I / ;s-- /
USE ZONE LOT AREA VACANT SITE
[3 YES
BUILDING ARNA VARIANCE NUMBER
EXISTING . STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT. 0
REMARKS I
0
Z
CHECKED BY I
By
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVI
[j YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
0 YES 0 NO
PLAN CHECKED 13Y
(W Plan Check No .....................
0 BUILDING
.4Ah d 14'04� - &0
PROPOSED USS PLUMBING
PLOT PLAN (Inatcato ijunaing setbacks, abutting streets) HEAT & GAS LINE
PENCE
14
SIGN
%
t RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby aeknowledge 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- ATTENTION
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 THIS PERMIT
ralating to Workmen'S Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
a, hall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
.17 CITY OF
EDIVIONDS
NOTE: Applicant Subject to Plan Chechce PR B-II07
This Permit covers work to be done on private property ONLY.
Any constructlot, on the public domain (curbs, Sidewalks, drIVOW&YO,
marquees, ate.) will require sepamte perraisslon.
Fee
I -W, 4V I
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-
lmowledged in space provided.
-7o
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