670039.pdfILDING DEPARTMENT Applicant Fill
inside licavy Lines
ERMIT APPLICATION
M.-%(OR, NAME OF BUSINESS)
N Rd
/�Ix llt�
IFTE-LEPHONE NUI
*,),- � /' — .3 4
/01
411
LEPHONE NUMB&
�70
El. —
E NUMBER CITY LAGENSis NUMy
40 1— S V �� � I —
::A 7 r
NEW
RESIDENTIAL I
F�
GAS
LINE
NON-RESIDENTIAL I
F-1
SIGN
ADD
RETAINING
WALL
F�
ALTER
DEMOLISH
EXCAVATE
OR FILL
PENCE
( .......... x .......... Ft.)
EjPRE
REPAIR
-MOVE
INSP.
swim
POOL
_1003V
POSTED ON ICROLL MAP Nu.: PRUMIT
NUMBER 6
j013 ADDRESS
EXISTING -STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT-
[3 YES [] NO
.:5- 1 M
0 YES
DEFICIENCY THIS PROPERTY I rZ
. . . . . . . . . . . .
C1MCK:HDjJ :J3YX:::j
Z
rA
0 YES [3 NO
I
DWELLING
UNITS
NATURE OF WORK TO BE DONE
I
I
ta K Z '4dd
Valuation Fee Receipt No.
Plan Check No .....................
-FR—OPOSED
PR USE
BUILDING
d=
919 5_0
PLOT PIjAN tinoicate �uijumti --9 streets)
PLUMBING
al
HEAT & GAS LINE
PENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
C'q
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A310UNT DUE
I hereby acknowledge that I have read this application; that the In
formation given In correct: and that I am the owner, or the duly authDi-
the owner. I agree to comply with city and state ISMO regu-
ATTENTION
APPLICATION APPROVAL
lzed agent of
tating construction; and in doing the work authorized thereby, no person
in of the Labor Code of the state of Washington
THIS PERMIT
This application is not a perinit until
will be employed violation
relatIng to Workman's Compensation Insurance.
AuTtionitzEs
signed by the Building Official or his Dep-
NOTE: Permit Limit one Year (Except DEMOLITIONS which
ONLY TIM
WOIUi NOTED
uty; and fees are paid, and receipt is ac-
shall be completed in ninety days; 31OVED-IN BUILDINGS shall be com.
Imowledged in space provided.
plated JR six months.)
NA UR E (U%VNJ�41, Ult 13IONED
INSPECTION
DIREC OR'S SIGNATU
r1.),'VTE
DEPARTMENT
CITY OF
Fee
EDMONDS
NNOTE: Applicant Subject to Plan Check
I'R (1-1107
This Permit covers work to be done on private proporty ONLY.
domain (curbs, sidewulks, drIveways,
FILE
Any construction on the public
marquees, etc.) will require separate permission.
I