700520.pdfPOSTED ON KROLL MAP NO-:
BUILDING DEPARTMENT
AppIlemant FIRI
'IN,
PERMIT APPLICATION
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jOB ADDRESS
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NAME
SIDE YARD SETBACK BTANk
MAILING ADDRE88
USE ZONE LOTA
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CITY
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EXCAVATE
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PENCE
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D REPAIR
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PRE -MOVE
INSP.
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SWIM
POOL
DWELLING
UNITS
NATURE Or WORK TO BE DONE
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PROPOSED USE
PLOT PLAN (Indicate Building setbacks, abutting streets)
PERMIT
NUMBER
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[:] YES E3 NO
STREET R/I
EXISTING STREET R/W ............
'Y
rT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............
IT. ........... IT.
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REMARKS
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CHECKED BY
METER SIZE SERVICE SIZE
CLEARANCE
CHECKED 13Y
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RVMARKS
TY NECTION
VERIFIED BY
PERC. TEST
PERMIT NU261BER
ARKS f7RL/ fi_4goo Wj� &-IZE PX(�f
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
[] YES 13VO
C] YES [:] NO
REMARKS I
Plan Check No.
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
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 lawn regu-
lating construction; and In doing the work authorized thereby, no 'Person
will be employed in violation of the Labor Code of the Slats of WaAhIngton
relating to Workmen's Compensation Imurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shalt be completed In ninety days: MOVED -IN BUILDINGS shall be win-
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
jj" o-c-1 1/0/70/70 1
NOTE: Applicant Snbject to Plan Check Fee
Thlb Permit coven work to be done on private property ONLY.
Aay construction on the public donx%In (curbs� sidewalks, drivewaysp
marquees, etc.) will require separate permission.
Valuation I Fee
No.
TOTAL AMOUNT DUE 10 C> 1(.5-1
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application Is not a perntit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDAIONDS
PR 0-1107
55- e) --
FILE
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