670247.pdf,im
"11MIrMn ON ICROLL MAP NO.:
FBUILDING DEPARTMENT Applicant FM
PERMIT APPLICATION Inside Ifeavy Lines
jNAMI (OR NAMID OF 5—USINESS)
L
al MA AU A-VJO EMS
91 Vr / Y V6
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CITY
CITY TELEPHONE NUM136"
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13IR eA
E] NEW
RESIDENTIAL
I
El
GAS
LINE
NON-RESIDENTIAL
F
SIGN
D0
H
"`rAINING
DEMOLISH
El ALTER
0
EXCAVATE
OR FILL
bj
7rEN�'E.
._X 2:)
3_
REPAIR
F-1
PRE -MOVE
INSP.
SWIM
POOL
;UMBER OF STOIffE_8
NUMBER OF
DWELLING
UNITS
;iumnan 6 JUZ4
I I my 1 0
US E ZONE LOT AREA v CANT SITE
PLOT PLAN APPROVE5
STREET R/W
EXISTING STREET R/W ............ Fr. DEFICIENCY THIS PROPERTY 0
......... FT.
COMP. P
REMARKS
CHECKED BY 0
A
14
C] YES E] NO
PERMIT NUMBER
OF CONSTRUCTION STREET IMPROVED
[3 YES NO
Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
94
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL Aj%IOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duly allthor-
Ited agent of the owner. I agree to comply with city and state laws regu- ATTENTION
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
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed in ninety days: MOVED -IN* BUILDINGS shall be com-
pleted In six months.)
NED INSPECTION
FATIJ NER AGEN
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Snbject to Plan Check- Fec PR 6-1107
This Permft covere work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will "quire separate permission.
Fee
1:Z,.e0 I
APPLICATION APPROVAL
Tlds application Is not a permit until
signed by the Building official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
FILE
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