700201.pdfON KROLL MAP NO.'.
BUILDING DEPARTMENT Applicant FIII
PERMIT APPLICATION� Inside Heavy Lines JOB ADDRESS
I NAME (OR NAME 0 INESS) j I / TY6
Z
22M -�-UVMAM
MUM
UtM
I 1`16�
PHONE N
— !::z ,
or AttaCn &our uopieB)
2-0/7 117161 6 "/-)-S
12 ve5- &<-) Iq
119
NEW
10 RESIDENTIAL
AS
GINE
IEl
NON-RESIDENTIAL
r I
SIGN
DADD
RETAINING
F1DEMOLISH
WALL
EXCAVATE
PENCE
ALTER
D
OR B`ILL
D
( x Ft.)
.......... ..........
REPAIR
PRE -MOVE
INSP.
El
swim
POOL
ZUBIBER OF STORIES
NUMBER OF
DWELLING
UNITS
qATURE OF WORK TO BE DONE
X-9Z , � � �l y /I �_, I Z __f�' tll-,' ,
' - - — -
—12
EXISTING STREET R/W ............ FT
COMP. PLAN ST. R/W ............ FT
[3 YES
MEMO
7 00/ig-
Plan Check No .............
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
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 arn 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 parson
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
I
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; BIOVED-IN BUILDINGS shall be com-
P�Rqd In six months.)
i URE (OWNER OR AGENT)
A BIG ED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
10TE: Apf(icantZubject to Plan Clleck'Fee
PR 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require sepwate permission.
PERMIT
NUMBER -700201
0 YES [3 NO
DEFICIENCY THIS PROPERTY
Z
04
STREET IMPROVED
[:] YES [] No
Fee
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his Dcp-
uty; and fees are paid, and receipt is ac-
Imowledged In space provided.
FILE
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