670118.pdfI
vi�ni D ON KROM " A P NO.: I PERMIT
DING DEPARTMENT Applicant FM
PERMIT APPLICATION Inside Heavy Lines =QB
NAM (OR NAME OF BUSINESS)
BID
J�
MALLI G ADD US
UE
q 10 'T'
CITY
XE�PHONID NUMBER
?0 HE
NAME
ADDRESS
EX
CITY
TELEPHONE NUMBER
C
RE
NAME
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94
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I
CITY
NUMBER
8
RE
STATE LICENSE NUMBER
CITY LICENSE NUMBER
T1
Legal Description of Property (Show Below or Attach Four Copies)
q 41 at 1:2
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Al C UZ 121- 7 1
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!4, Z e A .0 it/
P
GAS
RESIDENTIAL LINE R
El NEW
El NON-RESIDENTIJAL SIGN
ADD RETAINING
4"1 1:1 WALL
DEMOLISH F�
ALTER EXCAVATE PENCE
F� OR FILL 0 ( ......... . x .......... Ft.)
REPAIR PRE -MOVE swim
INSP. POOL
NUMBER OF STORIES
I NUMBER OF
DWELLING
UNITS
NATURF OF- WORK TO BE DONE
-,AdJ -2
Z
PROPOSED USE
abutting streets)
PLOT PLAN (Indicate Building setbacks,
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-
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
relating to Workmeres Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; AJOVED-n' BUILDINGS shall be com-
pleted in six months.)
SIGNATURE COWNIU" ult Au��41 DATE SIGNED
NOTE: Applicant Subject to Plan Chech Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drIv#Av&ys,
marquees, etc.) will require separate permission.
NUMBER 6 70 118
DDRESS
SETE1ACK
STREET BE BACK
REAR YARD
13ETBACK
=YARD
.,
NE
LOT ikil'
VACArd SITE
YES
�T"T."?Wn
A�M�
I VM11ANCIS
PIUMUNK
LEET R/W
(STING STREET R/W
............ M- DEFICIENCY THI 8 PROPERTY
OMP. PLAN ST. R/W
............ IT. .......... . I"
MARKS
CHECKED
Z
!TER SIZE SERVICE
SIZE CLEARANCE
MHECK
BY
I
I
IIIAJIKS
YES b-xo�
�,AN D BY,
EMARKS
Ilan Check No..
WILDING
ILUMBING
IEAT & GAS LINE
FENCE
3IGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AIMOUNT DUE
AT=NTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDDIONDS
PR 6-1107
1�_
I E3 YES 0-Tt6"
�NCY GROUP
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Fee
APPLICATION APPROVAL
No.
This application Is not a permit until
signed by the Building official or his Dep-
uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
r '.
7...e
15�
Building Department
city of Edmonds
lemen:
Gent
this letter is
Regarding the septioetank at the above address,
May, 1964.
to inform you that the tank was,last pumped in
again before the
If you so requestj we will have the tank pumped
the future will be res'�onsible
completion of our remoddlling and in
4i
for mainta±ntng the system in proper working order.
Very truly YOursi