670213.pdf0
DW1116 11116V to 111 11
PERMIT APPLICATION
NAME (OR NAME OF BUBINEUS)
-1::> ,4-- - 1, ^ . 'd A-?,
Aj
4�
POSTED ON KROLL MAP NO.: PER IT
I �Mmr.n k7n? i:�
Applicant kilt
Inside Beni CS I JOB ADDRESS
—t,ok ,c
0 0
I
— 0�4 � 1�'
g GAS
NEW RESIDENTLA LINE
NON -RESIDE TIAL SIGN
ADD RETAINING
DEMOLISH FJ WALL
ALTER EXCAVATE FENCE
OR FULL ( .......... x .......... Ft.)
REPAIR PRE -MOVE swim
El INSP. POOL
NUMBER OF
DWELLING
UNITS
VACANT SITE
[3 YES [3 No
VARIANCE NUMBER I W
EXISTING -STREET R/W ............ FT- DEFICIENCY THIS PROPERTY 10
COUP. PLAN ST. R/W ............ FT. -11
REMARKS W
CHECKED BY OX
I I W
METER SIZE I SERVICE SIZE I CLEARANCE CHECKED BY
REMARKS 19
[3 YES 0 NO
Finn Check No ............. .. ....
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMHING
BEAT & GAS LINE
FENCE
t
SIGN
RETAINING WALL
SWIM30NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT 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 lawn regu-
ATTEDMON
toting construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
TIUR PERIMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY '171E
NOTE: Permit Mmit One Year (Except DEMOLITION'S which
WORK NOTED
shall be completed in ninety days; 51OVED-IN BUILDINGS shall be com-
pleted In six months.)
-�IGNATUFET _(OWNER Oft AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
d-
its- a.
CITY OF
EDMONDS
NOTE: Applicant Subject to Plat; Check Fee
PR 6-1107
This Permit covers ivork to be done on private Property ONLY.
Any construction on the public dornaln (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Ej YES 13 NO
Valuation I Fee
3.
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.
DI
,7
,7R'S SIGNATU
FILE