700383.pdfa
Pos A
PERMIT
BUILDING
BUI
DEPARTMENT
Appileant Fin
NUMBER
PERMIT
FI—NAMN
APPLICATION
Inside Heavy Lines
jog ADDRESS
1
—
—
4.0
9 C) ()
88) �
01 !1XlMNG 151)
11/1 7J 7.
CITY
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1
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C4 ADDRESS
— Al Z
�AJ�2 ck"A,
CITY
STATE LICENSE NUMI
jffj�� 0 0 Ile, A VAR, i
TELEPHONE NUM
46 /il �, j >
7� I
Ow Below OF
�AR YARD SETBACK
.CANT BrI
YES NO
,R]ANCE NUMBER
EXISTING- STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.
REMARKS
RESIDENTIAL
OAS C] YES 0 NO
ff�LINE PLAN CHECKED BY
E!(xEw
ADD
1:1
rl
NON-RESIDENTIAL
SIGN
RETAINING REMARKS
ElDEMOLISH
WALL
DALTER
EXCAVATE
FENCE
I
D
OR FILL
( x Ft.)
REPAIR
1:1
PRE -MOVE
INSP.
.......... ..........
swim
El POOL
rUMBER OF STORIES
__C_
NUMBER OF
DWELLING
UNITS
Z
0
Ea/? IYA <?
e lAr /V��
Plan Check No .....................
BUILDING
PROPOSED USE
PLUMBING
u
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
PENCE
]EXCAVATION
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
formation given In correct; and that I am the owner. or the duly author-
lzed agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorized thereby, no person ATTENTION
will be employed In violation of the Labor 07-ode of the State of Washington TIUS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
n
'In ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
I
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
IIGNATURE (OWN It AGENT) DA ONED INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
NOA: Applicant Subject to Plan ChecVFce PR 5-1107
This Permit covers work to be done on private property ON
Any construction on the pubUc domain (turbo, sidewalks, driveways,
marquees, etc.) will require separate permission.
[] YES [] ITO
Valuation Fee
all
No.
1 5;-0 1 11"SIL q6
APPLICATION APPROVAL
This application is not a perrait until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
FILE