700458.pdfPOSTED
ON KROLL MAP NO.:
PERMIT
NUMBER -=458
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BUILDING DEPAR
Applicant Fill
PERMIT APPLICATION
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NAME (�Am� U- Dt*"'08)
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CITY
TELEPHONE NUMBER
STATE LICENSE NUMBER
CITY LICENSE NUMBER
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Legal Description of Property (Show Below or Attach Four Copies)
4— 16 1114 / 6 Y2:5� 77
-5114,1e oin
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741
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RESIDENTIAL F LINE
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EJAVV RETAINING F
ElDEMOLISH WALL
ALTER EXCAVATE PENCE
El OR FILL E] ( x Ft.)
........ . ..........
El REPAIR PRE -MOVE swim
El INSP. POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO B
PROPOSED USE
Q
Building
PLOT PLAN (Indicate setbacks, abutting street.)
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I hereby acknowledge 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.
lating construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Coda of the Blots of Washington
relating to Workman's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; BIOVED-114 BUILDINGS shall be com-
pleted In six months.)
SIGN T LE (OWNER Oft AG
DATE SIGNED
0") %.-� e� � 110ple
STREET SETBA
_-) Z-- /
E] NO
)T FLA ED
ISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
:OMP. PLAN ST. R/W 304.i�rr. .... 0 .... FT.
MARKS
)riveway slopes not to exceed those indicate w
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)n Standard drawing #103. 0 q
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RE ZONE I TYPE
YES &IN70
LAN CHECKE
3 Y.
Un Check No .....................
3UILDING
'LUMBING
1EAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
NOTE: Applicanhubject to Plait Chcck Fce r_Z
This Permit covers work to be done on privnte property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways$
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
A=NTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
DMONDS
PR 6-1107
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BY
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Valuation Fee_
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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-
knowledged in space provided.
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