670132.pdfM POSTED ON KROLL MAP NO.:
BUILDING DEPARTMENT Applicant Fill
7
PERMIT APPLICATION Inside Heavy Lines JOB ADDRE88
I NAME (OR NAME OF BUSINESS3
Peter �3alamonsen
5�?11,14
14
MAILING ADDRESS
-)-0
;r
P 0 Box 177
USE ZONE
LOT AREA
VACANT BF1'N
0, vo V
0 YES 0 NO
CITY TELEPHM rqUMBER
Lynnwood, Wn Pr. 6-1256
HEIGHT
VARI ANCE NUMUNIC
ow
NAME
Harve Harrison
PLOT
ADDRESS
STREET R/W
EXISTING STRE M, R/W ............ FT. DEFICIEN Cy THIS PROPERTY
0
CITY TELEPHONE NUMBER
4
Edmonds 6-3535
COMP. PLAN ST. R/W ............ Fr. ............ 7T.
9
Pr.
REMARKS
NAME
Peter Salamonsen
CHECKED BY
ADDRESS
same
METER SIZE SERVICE SIZE CLEARANCE
CHECKED By
CITY
TE"Pllublxi NUM ER
same
'NUMBEIR
REMARKS
STATE LICENSE NUMBER
CITY LICENSE
jifaiDescription of Property (Show Below or AttaiCn bour UOPICB)
S y2of following descr tract: WY2 of NWA
of NL14 of NLJ4 of Sec. 30j Twp 27 N.
Rg4 E WM less So. 2 acres thereof and
less county road; Snohomish County, Wn.
NEW
El RESIDENTIA
0
GAS
LINE
NON -RESIDE TIAL
SIGN
ADD
RETAINING
0
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
PENCE
( .......... x .......... Ft.)
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF
DWELLING
UNITS
Basement
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES [:I NO
SPECIAL INSPECTOR REQUIRED OCOUPANCY GROUP
YES NO
PROPOSED USE
Plan Check
BUILDING
PLOT P AN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given In 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.
litting conxtruction: and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
ATTENTION
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except IMMOLITIONS which
ONLY THE
IVORK NOTED
shall be completed in ninety days; .1ttOVED-IN' BUILDINGS shall be com-
pleted In six months.)
BIG ATUR (OW PR Oft AGENT) AT SIGNED
All
(t 4 7 7
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
NOTE: Applicant Stibject to Plait Check Fee
PR 6-1107
- This permit r,evers %vork to be done an privnic property ONLY.
Any construction on the Public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation I Fee
o 0
I allis'l
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-
Imowledged in space provided.
DATE
9
FILE
I
0
91
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