710137.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME )
S i (kL g H-d T C I+c12 c H
MAILING ADDRESS __A
2 i A05 •- iw2
CITY
TELEPHONE NUMBER
D Igo rJ OS IO2- 5,�-037 1
NAl1d
ADD
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C1T7
CU NS12u C7/o,rl/
DRESS L'
733c, is N.W
'y I TELEPH
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Description of Property (Show B Lego
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RESIDENTIAL
GAS
LINE
NEW
❑
NON-RESIDENTIAL
SICN
ADD
�
❑
RETAINING
El.�
DEMOLISH
FENCE
ALTER
I}
OROI-ILLTE
❑
t2
�.......... Ft.)
REPAIR
❑PRE
-MOVE
N
IP.
❑
SWIM
POOL
DWELLING
UNITS
t
N
I
I hereby acknowledge that I have rend this application; that the In-
formation given Is 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 State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE51OLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
\_
IAP NO.: PERMIT
NUMBER
fl)d P041
SI
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES
710137
,6L C.c.s.
REAR YARD SETB
VACANT SITE
❑ YES ❑ No
DEFICIENCY THIS PROPERTY
............FT.
STREET
❑ YES
'ID12Ar,u�s JO Ji�Cr 7i� XoPt*"Y�
. / "I V 4
Plan Check No .....................
Valuation
Fee
Recelpt No.
BUILDING
PLUMBING
HEAT d: GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
0,
TOTAL AMOUNT DUE
ATTENTION
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
APPLICATION
APPLICATION APPROVAL
This application is not a permit until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INAT RIK401VNER OR1,&GENT) D
ATE
-7 SIGNED INSPECTION
DEPARTMENT
CITY OF
EDAIONDS
NOTE: Applicant Subject to Plan Check Fee
Pit 8.1107
This Permit covers work to be done on private properly ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
DATE
FILE
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L RECORD OF INSPECTIONS *'
1' Date Passed
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