670234.pdfI
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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
HAMM (OR NAME OF BUSINEf)
JEOPIF
MAILING AD
7Y"`R4 ,A C E W r
4� 'a 0i� 3 0
CITY WE"PHONE NUUBER
a h�o oty 410 S
NAME
I ee) n e,
ADDRELS
.20j 104AC.C-,WFS7�
CITY WN"rtivriti NUMPER
E J0/0 ON 1) PR �9 -.2 918.2-
NAME
;Een4r-
ADDRESS 7*�
2 * s- Y 0.8,r P1. A f F
CITY T.W111SPAWNE FIBER
rPAA ON
STATE Ll?jENSE WU—MBER CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attph Four Copies)
LOT-Z"t. PLATOF.PIME
Z
0 VOL 13 P4 6(o
RS'00
komisH C044Nry
RESIDENTIAL
D
GAS
LINZ
FX� NEW
NON-RESIDENTIALJ
El
0 ADD
SIGN
RETAINING
DDEMOLISH
WALL
ElALTER
EXCAVATE
FENCE
0
OR FILL
El
( x Ft.)
D REPAIR
1:1
PRE -MOVE
INSP.
FI
.......... ..........
SWIM
POOL
ES
NUMBER OF
DWELLING
UNITS
PEILMIT
NUMBER
0 1�'�
IDE YARD SETIIAUK I STREET 8 0 ETHACK
71�%— 1 hn.% $n -,1- 9- 'k� I
IN
.5-1 I-h/*
13 YES
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. .......... 1".
[3 YES [3 NO
U -T I /. I T y S T
Plan Check No ................ . ...
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
CA
REAT & GAS LINE
P 0% 0 to 0 5' C" 1 )
rENCE
I I
pa I L p llvr:
SIGN
RETAINING WALL
I ev C_
SWIMMING POOL
PN JAI r
10., irmo M
DEMOLITION
AOA6
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-
ATTENTION
luting construction; and In doing the work authorized thereby, no ptroon
will be employed In violation of the Labor Code of the State of Washington
TIUS PERMT
relating to Workmen's Compensation Insurance.
AUTHOMzEs
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 nix months.)
INSPECTION
SIGNATURE (OWNER OR AGENT)
DATE SIGNED
.7 1 (-,A/ it--- '�:
el P� 4 1: .�e %:#
I Iq I
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check, Fee PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marqueeso etcJ svill require separate permission,
CONSTRUCTION
[j YES [3 NO
Valuation
F.ec,
Z
19 1 1
No.
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.
9T IG A
DATE
FILE
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