700557.pdfF
B U' ARTMINT
UILDING DEP
PEIRIT APPLICATION
CITY
C
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Cd ADDRESS
CITY
STATE LICENSE NUM5
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POSTED ON KROLL MAP 14U.: PERMIT
NUMBER Mot) I
can
Appli : t FIII
Inside Heavy Lines JOB ADDRESS
( --? ? 6-2-
CITY LICENSE,
or Attach Four C
81DE YARD SETBACK
STREET SETBACK
REAR YARD SETBACK
USE ZONE
LOW AltEA
VACANT SITE
1 [3 YES 13 Nc�%
HEIGHT
BUILDING AREA
I VARIANCE NUMUN"
ErRESIDENTIAL
GAS
RINEW
'L
NON-RESIDENTIAL
SIGN
RETAINING
WALL
DEMOLI I
0 ALTER
El
EXCAVATE
El
FENCE
Ft.)
OR FILL
( .......... x ..........
E] REPAIR
PRE-i.%IOVE
El INSP.
swim
POOL
;UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
PL V PLAN APPROVED
EXISTING'STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. RAV ............ FT. ............ FT.
I1W4;J0I
[] YES 0 NO
0 YES
PLAN CHECKEAYO
REMARKS
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ca cl"�r
0 t.)
92 61
t1m, A ..-- �L'. �_
I-141610RUCA
QFW,H-JJU*11
HEAT & GAS LINE
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 is 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- ATTENTION
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
I h
form t' 0
'zed a gen
latin coereby a n owl
given Is 0 rr
I so' th a 0 er
mp I ctlon
I be e Joy d I oled g 'hat I have read thl pp' Ica
ect 'hat I th wn cr, or "on
th a d
gree to comply with c' 'y d Bt to
ek 3 a that th In'
a a c aaa arn 0 a U'y au� or-
n I a an a laws regu-
g n ro and In doing the work authorized thereby, no person
c a vi all on of th e Labor Code of the state 0 f Washington
ral ng to Workmen's Compenaatt Insurance. AUTHORIZES
sit kno an as abcs
t Li it 0 ONLY TILE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
co
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months-�'
i W 0 T) E
Fl-G-NATURE (OW DAT _D INSPECTION
R AGE PE WNED
DEPARTMENT
CITY OF
EDAIONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drlv6wsLys.
nuLrquees, etc.) will require separate perminslon,
Z
14
Valuation I Fee I Receipt No.
M40
17 6 6 1 CS-Ir is,
APPLICATION APPROVAL
This application is not a pernift until
aigned by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
FILE
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1 4 . 1 4 l 11ECORIJ OF INSPECTIONS 9 9
Date Pawd
Foonidation,
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9 . 9 l I Plumbing- (Partial) 9 1 9 9
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9 1 RECORD OF. INSPECTIONS 9
Date Passed
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scaping 9,
Fire Dept, it
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