700473.pdf3 M17
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Legal Description of Property (Show Below or
- WN A
NEW
RESIDENTIAL
LINE
NON-RESIDENTIAL
SIGN
RETAINING
YWADIJ
DEMOLISH
WALL
F1ALTER
EXCAVATE
OR FILL
FENCE
( .......... x .......... Ft.)
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF
DWELLING
UNITS
0
D SETBACK I E
I rl� -
0
PERMIT
7064-78
NUMBFIR
1
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SETBACK
Rtt� YARD SETBACTI(
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0 YES -MIN 0
Ta— A
IER
bYrREET R/W
EXISTING STREET R/W ............ FT-
DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT-..
........... IV.
REM.&RKS
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CHECKED BY
METER SIZE SERVICE SIZE CLEARANCE
BY
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ICHECKED
04
REMARKS
TYPE CONNECTION I
VERIFIED BY
PERO. TEST
PERMIT NUMBER
REMARKS
LJA
-
FIRE F CONST.1.�UCTION STREET IMPROVED
1Z.,
0 YES [I NO_
SPALAL INSPECTOR REQUICRED
OCCUPANCY GROUP
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0 YES
PLAN CHECKED By
REMARKS
Plan Check No .....
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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 Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This permit covers work to be done an private property ONLY.
Any construction on the public domain (curbs, aldewalks, driveways,
marquees, etc.) %vill require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORIE NOTED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
PR 6-1107
Valuation
0 &-6
1�13-11
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APPLICATION APPROVAL
This application Is not a perinit 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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