670095.pdfPOSTED ON KROLL MAP NO.:
BUILDING DEPARTMENT
Applicant M
PERMITAPPLICATION Inside Heavy Lines JOB ADDRESS
'F(OR NAME OF BUSINESS)
A L 16- vi-
1 M o Aj jD M A oetyAJ SIDE YARD SETBACK STREET 1
MAILING ADDRESS
T FS t -x S 14 C_JeR A V USE ZONE LOT AAE
—di—TY TE"PjjVNE NUMBER
ciomemd I. ) IPJ/J-1 G ef a HEIGUT BUILDINI
NAME I
PLOT PLAN APPROVED
ADDRESS
STREET RIW
CITY TELEPHONE NUMBER EX3877NG STREET R/W ....... ... 3V-
COMP. PLAN ST. R/W ............ Fr.
REMARKS
NA=
I V A X FIAA
ADDRESS
aq(pi o r--joe 4A4 A u METER SIZE SERVICE SIZE C
CITY, TELEPHONE NUMBER
04 - —�Ooeo
5.41 A CSL
STATE; LICFORSE NUMBER crrr LICENSE NU�R
TYPE CONNECTION
Legal Description of Property (Show Below or Attach Four Copies)
c k i cexA Udl*50- PERO. TEST
REMARKS
FIRE! ZONE TYPE OF CONSTR
SPECIAL INSPECTOR REQUIRED
Ij YES [:I NO
PLAN MFGHECKED BY
GAS
NEW RESIDENTIAL LINE REMARKS
N ON E
-It SIDENTILL SIGN
RETAIMNG
DEMOLISH WALL
ALTER EXCAVATE PENCE
OR FILL El ( ........ . x ........ Ft.)
E] REPAIR PRE -MOVE SWIM
INSP. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
A o
Too s#c— b Plan Check No .....................
PROPOSED USE
[� e 0 fzoo M S BUILDING _4
PLOT PLAN (Indicate Building setbacks, abutting streets) PLUM[BING
22
HEAT & GAS LINE
PENCE
t SIGN
N
RETAINING WALT
SWIMMNG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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-
lzed agent of the owner. I agree to comply with city and state laws regu-
laung construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to WorkmerVa Compensation Insurance.
NOTE: Permit Limit One Year (Except DE31OLITIONS whlch
shal��e completed In ninety days: MOVED -IN BUILDINGS shall be com-
Plet6d liksix months.)
I
3-/7-67
NOTE: Applicant Subject to Plan Check Fee
__jW5 Permit covers work to be done on private property ONLY.
Any construction on the Public domain (curb$. sidewalks, driveways,
marquees, etc.) will require separate permission.
PERMIT
NUMBER 670095
E3 YES 0 NO
DEFICIENCY THIS PROPERTY
E3 YES [3 NO
Fee
00
I
z
14
9
TOTAL A51OUNT DUE 7. S__ o 3- 2:1
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowIedged In space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
�Z' I '<p
DATE
3 - 12 -