710588.pdf:.._.
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- - POSTED ON KROLL MAP NO.: PERMIT J.
BUILDING DEPARTMENT Appucunt Fill I NUMBER r,�. 13 I
PERMIT APPLICATION I Inside Heavy Lines JOB ADDRESS
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NAME (OR NAME OF BUSINESS) - I A (A1 I / L , / i
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MAILING ADDRESS
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CITY TELEPHONE NUMDER
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NAME
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CITY
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STATE LICENSE NUMBER -
I CITY LICENSE NUMBER.
Legal Description of Property (Show Below or Attach Four Copies)-
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RESIDENTIAL GAS
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�: NON-RESIDENTIAL ❑ SIGN
ADD RETAIKING
❑ DEMOLISH EJ WALL
ElALTER EXCAVATE FENCE
OR FILL (x. )
❑ ❑
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REPAIR ❑ -MOVE swim
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INSP. POOL
DWELLING
UNITS
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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 -
(zed agent of the owner. I agree to comply with city and state laws 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 DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
'IF—�'� ,w—ZI—i/
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
USE ZONE
LOT AREA -
VACANT B TN
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I BUILDING AREA I
VARIANCE NUMBER.
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PLOT PLAN APPROVED - -
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8TREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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COMP. PLAN ST. R/W ............FT. ........FT.
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REMARKS
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CHECKED BY
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
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REMARKS
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TYPE CONNECTION -;I
VERIFIED BY
PERO. TEST -- -
PERMIT NUMBER -
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YES
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BTRUCT�ON STREET IMPROVED
REQUIRED- I OCCUP� OROU
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BY THIS SITE IS LOC;W E • !N _1HL
CITY OF EDR•1CHDS L'.1 1' SALES j
REMARKd TAX SHOULD BE GODED ji.U4.
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Valuation
Fee
Receipt No.
Plan Check No .....................
BUILDING
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PLUMBING
HEAT A GAS LINE
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FENCE
SIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
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PRE -MOVE INSPECTION
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EXCAVATION OR FILL
TOTAL AMOUNT DUE
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ATTENTION
APPLICATION APPROVAL
TIHB PERMIT
This application is not a permit 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
DIRE 'B 81cwt TYRE
CITY OF
—
EDNIONDS
DATE
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�"� -7
PR 6.1107
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