670212.pdfPOSTED ON KROLL MAP NO.:
:DING DEPARTMENT Applicant Fill
MIT APPLICATION Liside Heavy Lines JOB ADDRESS
am (OR NAME OF BUSINESS) RICE; 141711- V -:��
rA , //? - -A— 1 81DE YARD SETBACK I STREET 8
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or
NEW
RESIDENTIA
,,
GAS
LINE
NON -RESIDE TIAL
SIGN
ElADD
RETAINING
0
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
PENCE
( x FL)
.......... ..........
REPAIR
PRE -MOVE
INSP.
svnm
POOL
NUMBER OF
DWELLING
UNITS
PERMIT
NUMBER 670212
VACANT SITE
[] YES [3 110
LREA I VARIANCE NUMBER
EXISTING -STREET R/W ............ FT.
DEFICIENCY THIS PROPERTY
0
COMP. PLAN ST. R/W ............ FT.
............ FT.
REMARKS
CHECKED BY
Z
ZONE
[3 YES [3 NO
0
Plan Check No .....................
P I n C h ce N
B I
BUILDING
U I N G
L'3
PLUMBING
P L U M N
a U N E
HEAT & GA13 LINE
HE & G A
AT
E
FENCE
N C E
t
14
I
SIGN
G N
A LL
RETAINING WALL
E T Al NJ N W
SWIMMING POOL
DEMOLITION
OV P CTION
P p E M INS
RE -MOVE INSPECTION
FILL
EXCAVATION OR FILL
EXC V TION 0
TOTAL AMOUNT DUE
'T
TOT L MOUN
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 rsgu-
A TTENTION
tating construction; and In doing the work authorized thereby. no person
wIll be employed In violation of the Labor Code of the State of Washington
THIS PE101IT
relaUng to Workmen's Compensation Insurance.
AUTHORIZES
014LY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
I
WORK NOTED
Bball be completed In ninety days; MOVED -IN BUILDINGS shall be Wm-
pleted in six months.)
3I(TURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
0 YES 0 NO
Valuation I Fee
1 3. 0 o I
APPLICATION APPROVAL
This application is not a pern-dt until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in spabe provided.
.0
CITY OF DATAPIr
EDMONDS
NOTE: Applicant Sitbiect to Plan Check Fee PH 6-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate permission.
I
I j
41
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