670271.pdfAl
POSTEI
BUILDING DEPARTMENT
PERIT APPLICATION
NAM"R NAME OF BUSINE
1 1
�y Vd 7-r46�,
MAILING ADDRESS
/m /, 17. 1-- V,7,i Id f 'Itl
Applicant Fill
Inside Heavy Lines
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or AtLaCb/
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NO.:
PERMIT
NUMBER 670271
. _-.1 &4. S 7- 's.
I/-I " , M I, , I -X ' (\1) i 4 1 / S_ I MJI N
USE ZONE LOT AREA VACANT SITE
01 � 6 1 i "a 1`1 NO
RESIDENTIA L
AS
G I
LIN 1E
ERNEW
ElNON
-RESIDE NTL&L
SIGN
D�
RETAINING
R
WALL
ElALTER
DEMOLISH
EXCAVATE
FENCE
F1
El
OR FILL
( .......... x .......... rt.)
REPAIR
1:1
PRE -MOVE
INSP.
SWIM
POOL
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
M
4)
STREET R/W
EN38TING STREET It/W ��T. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ IT. .... �2 ... FT.
q 1 3
El YES
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
N
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 is 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.
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
THIS PEI1tMIT
relating to Workmen's Compennation Insurance,
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety yd; MOVED -IN BUILDINGS ahall be com-
pleted In six months.) 9110
y1ENT)
,,(OWNN1t U�K A
31ONATUW
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
Pit 0-1101
This I -emit covers nrork to be done on private property ONLY.
Any construction on the public domain (curbe. sidewalks, driveways,
marquecs, etc.) will require separate permission.
BY
!E7 BY
BER
STREET IMPROVED
XyEs 13 -To
GROUP
I
4—
Fee
f.5Y,.oc
/;�,00
1 6�,64) 1
APPLICATION APPROVAL
I
No.
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.
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