670052.pdfPOSTED ON KROLL MAP NO-:
BUILDING DEPARTMENT Applicant FM Ll
inside Heavy Lines JOB ADDRESS
PERMIT APPLICATION
NAME (0)t NAME.
Z
SIDIrrYARD P�=BAC STREET i
LOT ARM
USE ZONE
17,119
CITY LE
IGHT �JBUMDINC
NAME
LIDT P14S A OVED
A -DDREM
R/W
............ In.
=87107WNG STREET R/W
TELEPHONE NUMBER
17.
COMP. PLAN ST. R/W ......
NAME
ADDRE�y
METER SIZE BERVICE.BIZE C
CITY
13TATS LICENSE RUM—BER CITY LICENSE NUMBER
I TYPE CONN19TION
Legal Descriptlon of Property (Show Below or Attach Your CUPI65)
PERO. TE11T
V
Z
7 Al Ir �1 Z0 ;t/ A/ MARKS
TYPE OF COWS
>1
1Z
YES
QXO
PLAN CHE KEIYBY
GAS k
/�< I � 7/
RESIDENTIAL LINE REMARK#
NEW
NO
E2 N-RESIDENTLALL SIGN
F'II1 �" RETAIMNG
FI1DEMOLISH WALL
ALTER EXCAVATE PENCE
n OR FILL ( ........ . x .......... Ft.)
REPAIR PRE -MOVE SMM
0 INSP. POOL
DWELLING
UNITS
Plan Check No .............. .....
BUILDING
PLUMBING
_qJ
i:
-C
C
C]
t
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIM NG POOL
DEMOLITION
PRE -MOVE INSPECTION
I- EXCAVATION OR FILL
'P_ Z7
TOTAL AMOUNT 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 author -
lend agent of the owner. I agree to comply with city and state laws regu-
IaUng construction; and In doing the work authorized thereby, no person
WHI be employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance -
NOTE: Permit Limit One Your (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS ahall be oom.
pleted in six months.)
NOTE: APPlicant Subject to Plan Check Fee
_iFd's —rem-dt covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
m"qufts, etc.) will require separate permission.
ATTENTION
THISPERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
CITY OF
EDMONDS
PH 6-1107
PERMIT
NUMBER 67
E3 NO
DEFICIENCY THIS PROPERTr
Al I -
opit . ......... j".
13 YES
Valuation I Fee
I r�r'el a 1 3 ��21
APPLICATION APPROVAL
This application is not a perntit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
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