670037.pdfDING DEPARTMENT I Applicant FlU
MIT APPLICATION lInside Heavy Lines
(OR NAME OF BUSINESS)
K
,,REEI`- 4 N QU S
iG ADDRESS
�_3 ) �Y, (-j ytt-)
M 6 Il 0-5, 14-) r - 4 - /-/ 41 o
4jj EL
TELEPHC
i—)Oj ml 6/ D& e S _� Lj PPL
LDDREB8
6 00 ? .2 411V_5 &0
)ITY TELEPHONE NUO
Vo viv la"i T& r rl) C & rt, -�`v - s- - --)) [ �
3TATE LICENSE NUMBER, CITY LICENSE 14U.
222301 3P;2,
Legal Description of Property (Show Below or Attach Four Copli
V0A D
NEW
RESIDENTIA
GAS
LINE
I
1Z
NON-REBIDT TIAL
SIGN
MADD
RETAINING
ElDEMOLISH
WALL
13
EXCAVATE
PENCE
ALTER
n
OR FILL
( x .......... Pt.)
El REPAIR
R
PRE -MOVE
INSP.
..........
swim
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
oL)E- L
c) it-, /k r e
R-HROLL MAP NO.: PERMI
NUMBER
.ESS
�3 -
3 - / � �, - X -
13 YES [3 NO
EXISTING STREET R/W ........... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ........ ... 1".
[3 YES (3 NO
Plan Check No ............ . .......
PROPOSED USE BUILDING
5 PLOT PLAN (indicate Building setbacks, abutting streets) PLUMBING
YIEAT & GAS LINE
PENCE
t SIGN
N
RETAINING WALL
SWIMMING 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 to 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- ATTENTION
lating construcUon; and In doing the work authorized thereby, no person
will be employed in violation Of the Labor Code of the State of Washington TIUS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY TM
NOTE: Permit Limit One Year (Except DE51OLITION'S which JIVORK NOTED
shall be completed to ninety days; MOVED -IN BUILDINGS shall be COM.
pleted in mix months.)
BIG ATURE (ONVZ7 oft AGENT) DAT SIGN D INSPECTION
DEPARTMENT
716/�zi -,z -j V�� X e 7 76 CITY OF
wnsii EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on ills public domain (curbs, sidewniks. driveways,
marquees, etc.) will require separate permission.
Valuation
0 YES Ej No
Fee
0
J
Z
L
No.
I / 6. " I -�) S:-6 �/
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.
, C-11 �
FILE