670127.pdf13-1.11LDING DEPARTMENT I Applicant F111
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
Afifr7le clacz_ Z_ 141
MALLAING "DAZU�
PHONE NUMBER
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XURESIS
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CITY TELEPHONE N MBER
JM/V
__6T_ATE LICENSE NUUBER CITY LIGN14blu NUMBER
3 �� 3 -5 9 1, 1
t�rmi nPnerintion of Pronerty (Show BeRTW —Or Attach Four copies)
RESIDENTIAL
GAS
LINE
NEW
NON-RESIDENTIAL
SIGN
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
OR FILL
FENCE
( x .......... Ft.)
..........
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF
DWELLING
UNITS
srATURE OF W00C—TO BE DONE
1ZP1?'r11%1A7_M'
POSTED ON KROLL MAP NO.: PERMIT
NUMBER
JOB ADDRESS
.1Z
SIDE YARD 13ET13ACK TRE BETBAUK RjAjt YARD SETBACK
-) 13
LOT AREA 7VACANZSITE�
_ �7 i
[] YES [3 NO i i
VARIANCE NUMBER 04
HEIGHT BU. ING AREA
PLOT P N APPROVED
M.... ../"
EXISTING STREET R/W ..... ...... FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT- ........... FT.
[3 YES [] NO
Plan Check No ... . ................
BUILDING
PLOT PLAN (Indicate Building setbac PLUMBING
03
HEAT & GAS LINE
FENCE
tSIGN C�
RETAINING WALL
SWIJJMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the in. TOTAL AMOUNT DUE
formation given to 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 rcgu- 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 TIDS PEnMIT
relating to Workmens Compensation Insurance- AUTHOIUZES
ONLY THE
NOTE: Permit Limit One Year (Except DE31OLITIONS which WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.) INSPECTION
BIG ATURE-FOWNER OR AGENT) DATE SIGNED DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6.1107
This PermJt covers work to he done on privulte 1m,lierty ONLY.
Any construction on the public domain (curbs, sidewalks. drivoways,
marquees, etc.) will require separate permission.
[3 YES [3 NO
Fee
.0
I 5'(D n I
Z
W
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.
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