670208.pdf.. ... ... . ... .. .......
KROLL MAP No.:
BUILDING DEP,NRTMENT Applicant Fill POBTFD ON
inside Heavy Lines JOB ADDRESS
PERMIT APPLICATION I I
I NAJIZ,(OR NAME OF BUSINESSn 1 14-5,9.3-
XAILI1 �G
TELEF
tgal Description of Property (Show Mlow or I
0
L
OF se-U.Ir 7-w"Ityp, 'X'�
PERMIT
NUMBER
f>61-
,CANT SITE
YES [3 NO
,RIANCE NUMBER
EXISTING'sTREErr n/W .......... FT.
COUP. PLAN ST. R/W ............ FT-
DEFICIENCY THIS PROPERTY
.......... FT.
REMARKS
11 GHEMED BY
z
W
METER SIZE I SERVICE SIZE I CLEAR.414CE
ICHMCKED BY
ca
E NUMBER
RE KARKB
IIIIE NUMBER
TYPE CONNECTION
I VERIFIED BY
)ur Copies)
E
F/_ '111� I
c) ?7 C- e-
S' , A ej-r
[3 YES [] NO
PLAN CHECKED BY
Ea %glENTIAL
F�
GjA11r
L N
NEW
I
,
El
NON-RESIDENTIAL
SIGN
0 ��
RETAINING
DEMOLISH
WALL
EXCAVATE
PENCE
ALTER
OR FILL
( x Ft.)
.......... ..........
REPAIR
PRE -MOVE
INSP.
El
swim
POOL
1UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
R
Plan Check No .....................
PROPOSED USE
PLOT PLAN (Indicate Building setbacks, abutting streets)
BUILDING
PLUMBING
BEAT & GAS LINE
FENCE
t
SIGN
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.
Ized agent of the owner. I agree to comply with city and state laws regu.
luting construction; and In doing the work authorized thereby, no person
ATMNTION
will be employed In violation of the Labor Code of the State of Washington
TIUS PERMIT
relating to WorkmerVO Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NSPECTION
DEPARTMENT
CITY OF
EDIMONDS
BIG ATURE (OWNER OR AGENT)
DAT SIGNRD
WOTE: Applicant Sll�'C� to Plan deck Flee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbso sidewalkag drivewayso
marquees, etc.) will require separate permission.
Valuation
00
YES
5-
NO
No.
5,00 F
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.
I IV, .01
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FILE
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