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I$UILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Linos
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Q KROLL MAP NO.: I PERM
NUMBER 710069 II
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❑ YES ❑ 1
HEIGHT I BUILDING AREA I VARIANCE NUMBER
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PLOT PLAN APPROVED
STREET R/W '
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT. p
REMARKS
AS 10 O
BY
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STATELICENSE NUMBER
CITY LICENSE NUMBERi.
METER SIZE SERVICE SIZE
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CLEARANCE CHECKED
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Legal Description of Property (Show Below or Attti/itch Four Copies)
REMARILB3
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TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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❑ YES ❑ NO
GAS
RESIDENTIAL ❑ LINE
SPECIAL INSPECTOR REQUIRED
❑ YES ❑ NO
OCCUPANCY GROUP
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❑ NEW
PLAN CHECKED BY
❑NON-RESIDENTIAL ❑ SIGN
❑ ADD RETAINING
WALL
REMARK
DEMOLISH
FENCE
ALTER ElOR
OR FILL (.......... x.......... Ft.)El
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REPAIR ❑ PRE-INSP. ❑ POOL
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NUMBER OF STORIES NUMBER OF
DWELLING
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UNITS
II
NA`19=4 OF WORK TO HE DYOL
Valuation
Fee
Receipt No.
Plan Check No .....................
BUILDING
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PROPOSED USE
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PLUMBING
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a PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT &GAS LINE
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FENCE
1®al
SIGN
RETAINING WALL
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SWIMMING POOL
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DEMOLITION
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PRE -MOVE INSPECTION
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EXCAVATION OR FILL
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TOTAL AMOUNT DUE
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I hereby acknowledge that I have read this application; that the In-
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formation given to correct; and that I am the owner, or the duly author-
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ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
APPLICATION APPROVAL
lacing 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
This application Is not a permit Lentil,
relating to Workmen's Compensatioa Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
uty; and fees are paid, and receipt Is ac-
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
pleted In six months.)
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BION (OWNER OR AGENT) DATE SIGNED
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INSPECTION
DEPARTMENT
DI TOR'8 NAT
Y�l�u ui,Ur]�r
CITY OF
EDAIONDS
DATE
v NOTE: Applicant Subject to Plan Check Fee
PR a-Ilor
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
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marquees, etc.) will require separate permission.
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