710381.pdfI
POSTED ON KROLL MAP NO.: I MomsT 710381
DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS//
FBUILDING
NAME (OR NAME OF BUSINESS) • ^ S.
N
O
CC
AD��D4REESSS�
CITY
r 21K /-/-r& //V C-
TELEPHONE NUMBS.
3t�
or
RESIDENTIAL
S AS r) e Y
LINE
❑ NEW
NON-RESIDENTIAL
❑
SIGN
❑ ADD
❑
❑
RETAINING
DEMOLISH
EXCAVATE
ALTER
❑
ORFILL
❑
(ENC.x.......... Ft.)
❑ REPAIR
❑
PRE-INSP.
El
Pwim
OOL
LUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
9S-ram
❑ YES ❑ NO
EXISTING. STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
FIRE ZONE
❑ YES ❑ NO
❑ YES ❑ NO
PLAN CHEUKEU ux THIS SITE IS LOCATED IN THE
CITY OF EDMONns I nrnl SAL
c
REMARKS TAX SHOULD BE CODED 31.04,
NATURE OF WORK TO BE DONE
Valuation
Fee
Receipt No, it
Plan Check No .....................
BUILDING
PROPOSED USE
�
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
O
n
FENCE
�
SIGN
RETAINING WALL
I
ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
!
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_
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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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-
l
Ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
APPLICATION APPROVAL '
lating construction; and In doing the work authorized thereby, no person
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Will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep- j
NOTE: Permit Limit One Year (Except DE11OLITIONI; which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be corn-
kROWle d in space pr vlded. •,
pleted In six months.)
,
SIGNATURE (O NER OR ENT) DATE SIGNED
INSPECTION
DIRE
DEPARTMENT
r
/ �/
V"
CITY OF
EDMONDS
DATE _ /1
/�-�/�"J
NOTE: A scant Subject to Plan Check Fee
.� 3,.--7/;
PR 6-1101
--/
This Permit coven work to be done on private property ONLY.
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Any construction on the public domain (curbs, sidewalks, drlveways,
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marquees, etc.) will require separate permission.
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