670066.pdf__7
F BUILDING DEPARTMENT
PERMIT APPLICATION
AME or 13USIM08)
TOMLINSON2 INC.
as
12,65 REPUBLICAN ST
Ty
rw I TEL
Applicant Fill
inside Heavy Lines
SEATTLE, WASH 9,5109 DIA 3 -
NAME
ADDRESS
CITY TICLEPHC
NAME
ADDRESS
14' CITY I TE"PIN
Wu-tached)
700
GAS
E] RESIDENTIA LINE
NEW 0
1
2 NON-RESIDI TIAL F-1 SIGN
0 RETAINING
MDEMOLISH WALL
FEALTER EXCAVATE PENCE
D OR FILL I x Ft.)
.......... ..........
REPAIR PRE -MOVE SWIM
1:1 INSP. POOL
ES
NUM33ER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
IMXrA oy&1A00 57-V9&T,0I`24Af7-
Z
PERMIT
NUMBER 670066
VAC UM SITE
[] YES 13 NO
vARxANcju NUMBER ow
EXISTING STREET R/W ............ FT- DEFICIENCY THIS PROPERTr 0
COMP. PLAN ST. R/W ............ FT- ........... PT.
REMARKS
CHECKED BY Z
I N
METER SIZE I SERVICE SIZE I CLEARANCE CHECKEID 13Y
REMARKS 9
0 YES 0 NO
wi N 0 W.5 )or eL)eA1,4-P 4LA 5!5 - CO - Plan Check No ............ . .......
-TROPOSED USE :IE-A 77LE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In-
formation given is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
iating constructlon; and In doing the work authorized thereby, no person
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
THISPERMT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six mOnthfi-)
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
SIGNXTURE �(OWNER OR AGENT) DATE SIGNED
a,-no&V& .�46 6)7
ae
5��
V V
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
_iga _ftrnut covers work to be done on private Property ONLY.
Any construction on the public domain (curbe, iddewalkst drivewaysp
marquees, ate.) will require separate permission.
[] YES 13 NO
Valuation
0 /) �01
NO.
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.
DMECTOR'S BIONATUFJi;
col — t)
FILE
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