710428.pdfr
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' BUILDING DEPARTMENT I Applicant Fill PL
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NAME (OP. NAME OF IIUBINESS)
W �% 9/0EN G,a
MAILING ADDRESS
CITY TF',LEPFIONE ]
or
E
6
NEW
RESIDENTIAL
❑
GAS
LINE
NON-RESIDENTIAL
❑
SIGN
❑KING
ADD
Q
WALL
❑
Ijtl1 ALTER
El
DEMOLISH
OR FILL
OR
FENCE
(.......... x.......... Ft.)
REPAIR
❑
PRE -
INSP.
^�
1 1
swim
POOL
IUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
l
,STED ON KROLL MAP NO.: PERMIT
NUMBER I O4^L8
B ADDRESS
DE YARD BETBACK I gTREET SETBACK I REAR YARD BETDACI(
' cQ � / � /
� VV °
BE ypp I LOT AREA I VACANT gIT1'
r/'/Ci�S � ❑ YEg NO
rntam I AUILDIN6 AREA VARIANCE UMBER M
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
CONSTRUCTION
❑ YES ❑ NO
❑ YES ❑ NO
THIS SITE IS LOCATED IN THE
r
REMARKS
TAX SHOULD BE CODED 31.04.
Plan Check No .....................
BUILDING
PLUMBING
HEAT do GAS LINE
FENCE
SIGN
tRETAINING WALL
N
ISWIMMING 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.
Ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
lating construction; and In doing the work authorizel thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; 11tOVED-IN BUILDINGS shall be com.
pleted In six months.)
SIGNATURE (OWNER OR 6E ) DATE SIGNED
INSPECTION
DEPARTMENT
S /
CITY OF
EDIIIONDS
NOTE: AppliciWit Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done on privnte property ONLY.
Any construction on the public domain (curbs, sidewalks, drlvoways,
marquees, elcJ will require separate permission.
Valuation I Fee
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No.
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.
DATE
FILE
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