670099.pdfgw"
RDING DEPARTMENT
NUMIT APPLICATION
F'9�r (OR NAME or BUSINESS)
�'�4 I- -/ 4 1, V- /n , -.r /
Applicant Fill / / 5—
Inside Heavy Lines -YOU ADDRESS
o0o
2
NUM30
7;
TELEPHONE NUMnv-1
t.N_UMBER
ITY LICENSE NURE
r
ption of lijoperty (Show Below or Attach Four coples)
-C'. YL
4f
jF p .3
J) 4
A,14
Z
I
NEW
A"V
ALTER
REPAIR
ATURE
lvr- �'
PERMIT
NUMBER
VACAN7.r b&'Km
0,fi-s- p No
CISTING STREET n/W -j�.... FT. DEFICIENCY THIS PROPERTY
cOMP. PLAN ST. R(W 46. V.
, 1/1. A P 0 __, 1;
RESIDENTIAL I
[:]
GAS
LINE
NON-RESIDENTIALI
D
SIGN
ElDEMOLISH
RETAINING
WALL
FENCE
EEXCAVATE
lOR
FILL
( .......... x .......... Ft.)
PRE -MOVE
E3
SWIM
INSP.
POOL
LIES
NUMBER OF
DWELLING
UNITS
� JL
it
ik
OF CONST.,
I[] YES P-140 1
PLAN CHECKED T3Y
REMARKS
r",
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FE14CE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
A
TOTAL A31OUNT DUE
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-
ized agent of the owner- I agree to comply with city and state laws regu-
ATTENTION
lating construction; 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 WorkmerV5 COMPensc-tiOn Insurance-
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
INSPECTION
__:_�UATE SIGN-ED
SIGNATURE (OWNER OR AGENT)
DEPARTMENT
CITY OF
EDITIONDS
Applicant Sitbject to Plan Check Fee
NOTE:
PR 0-1107
This Perfult covers work to be done on private property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways,
marquees, etc.) will require separate pertnisslon.
Valuation
I
[3 YES
'r /-., 11)
Z
41
I
QQ
No.
APPLICATION APPROVAL
This application is not a permit until
signed by the Building official or his Dep-
uty; and f ees are paid, and receipt is ac-
knowledged in space provided.
FILE
ed along the South line, of Lot 23)
dl The west 72 feet, as measur at recorded in
East -Edmonds Acres, Division No 2, as per pl
unty*
66, r
ords of Snohomish CO
Volume 121. of Plats, page
�gt"'
6 -70099
sr
4-2
I