670187.pdf. .... . ....... .... .
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G,DEPARTMENT I Applicant FBI
APPLICATIONInside Heavy Lines J013 AD
UM OF BUSINESS)
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ME NUMBER CITY LICENSE NUM13E
tion of Property (Show Below or Attach Four Copies)
"-� )�� �JIA MAd C Af "f A) 0 ;V ;;Z
U AtAr �V.; PERMIT
NUMBER 67018
ACK STREET SETBACK REAR YARD 8k;TbACK L
LOT -AREA VACAIWX 13IT11;
13 YES NO
VARIANCE NUMBER
OVED
EXISTING I STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ M. —
ZONE
N047AI 7J
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.XCf_,,'r
.2-/
/,6,67- 0 r U16) 95 AeAS7'
[] YES
PLAN
0
NEW
ALTER
REPAIR
LrVI
C�j RESIDENTIAL
I E] NON-RESIDENTIAL
DEMOLISH
EXCAVATE
F] OR FILL
PRE -MOVE
El INSP.
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( .......... x .......... Ft.)
SWIM
POOL
REMAJ
I
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
[3 NO
0 YES [] NO
Valuation I Fee
Z
154
I
No.
Ptan Check No ... ......... .......
PROPOSED USE
BUILDING
Q
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
PRE'M
EXCAVATION OR FILL
EXCA V
TOTAL A1,R)UNT DUE
TOTAL
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-
..
ized agent of the owner. I agree to comply with city and state laws regu-
ATMNTION
A
APPLICATION APPROVAL
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
7
This application Is not a permit until
relattag to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit one Year (Except DE31OLITIONS which
ONLY THE
WORK NOTED
'V
uty; arid fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in space provided,
pleted In aim months.)
SIGNA UJI.E. (07NER OR AGENT) DATE SIGNED
INSPECTION
D;IrREC R'J
DEPARTMENT
J/9 /
1>
CITY OF
Plats Ched, Fee
EDMONDS
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NOTE: Applicant Subject to
_�T
PR 6.1107
This Pemdt covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permlssl�n.
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