700496.pdf_1UU4V6
POSTED ON KROLL MAP NO.: PERMIT
/ a NUMBER
BUILDING DEPARTMENT Applicant Fl:
PERMIT APPLICATION Inside 111cavy 1,11nes jGH ADDRESS
I IJAME (OR NAME or IJUSINESS)
0� .
94
1
t
Q
Q
USE ZONE LOT AREA
VACANT BITE
I TELEPHONE NUMBLR
YES NO
Z
HEIGHT BUILDING AREA
VARIANCk; Nualls"ts
PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT.
............ FT.
0
REMARKS
ra
is
Z
xe
CHECKED BY
TELEPHONE NUMBER
7,,7C-M
METER SIZE SIZE CLEARANCE
BY
SERVICE
CHECKED
L CE148N riuw�mjt
ITY LICENSE NUMBER
1C
REMARKS
3scription of Property
---
(Show Below or Attach Four Copies)
TYPE CONNECTION VERIFIED
BY
PERC. TEST PERMIT NUMBER
REMARKS
to
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
RESIDENTIAL
0
GAS
LINE
NEW
I
j
E]
NON-RESIDENTIAL
SIGN
F] AVU
RETAINING
El
DEMOLIS__
El
WALL
ElALTER
EXCAVATE
PENCE
D
OR FILL
( x Ft.)
.......... ..........
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
quMB STORIES
NUMBER OF
=RoF
DWELLING
UNITS _07--w—
C] YES 0 NO
REMARKS
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE E
PENCE
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 �s 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. AT=NTION
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 THIS PERMIT
at ]Lh�ln
I y au or'
We r8ga'
no person
JashIngton
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY TILE
I w
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be rom-
Pleted In six months.)
lIGNATURE (OWNER 0 GENT) DATE SIGNED INSPECTION
DEPARTMENT
7 70
0 CITY OF
EDIVIONDS
NOTE: ApplicattlSubject to Plan Chech Fee PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
maxqueesp etc.) will require separate permission,
Valuation
[] YES 0 No
Fee
5
APPLICATION APPROVAL
ler-1
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
ImowIedged in space provided.
FILE
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�PECTIONS
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Sower'
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Parking
Landscaping'
Fire Depto
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