670302.pdf. ....... ..
IMILINN1111 POSTED ON KROLL MAP NO.: PERMIT '70300L
n ii i i niud%- nCD A PTRACMT 1 NUMBER 6 1 1---
PERMIT APPLICATION
NATMID (OR NAME OF BUSINESS)
ffA /:Z_M 14 Rif
0 ADDRESS
'Umomp-S, 7—
CITY
tP 140 A60 -9
Applicant Fin
Inside Heavy Lines
.2 0 CP fj�
FE-LEPHONE NUMBR
PR 11 Z? 9 U5
A 40 0 , Cs k--*,
ADDRESS
CITY TELEPHONE NUMBX=R
toNjo j
ElNEW
a K"v
DALTER
1:1 REPAIR
or
RESIDENTIA
AS
ZIN E
NON -RESIDE NTJ1AL
R
SIGN
DEMOLISH
RETAINING
WALL
EXCAVATE
OR FILL
PENCE
( .......... x .......... Ft.)
FPRE
�
-MOVE
INSP.
F-1
SWIM
POOL
DWELLING
UNITS
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 laws regu-
lating constrUCUOn: and In doing the work authorized thereby, no person
will be employed In Violation Of the Labor Code of the State of Washington
relaUng to Workmens Compensation Insurance.
NOTE: Permit Limit One Year (Except DE31OLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
3, OP,
NOTE: APPlicant Subject to Plan Check Fee
This Fermit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
"Loa
EXISTING STREET R/W ............ FT.
COUP. PLAN ST. R/W ............ FT.
0 YES
TYPE
[3 NO
Plan Check No ............
BUILDING �M.
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1101
I
VACANT BITE
E] YES 13 No
VARIANCE NUM"Un aw
DEFICIENCY THIS PROPERTY
0 YES 0 ITO
MAV
Valuation I Fee
1 5-6 V a I
Z
N
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-
lmowledged in space provided.
I
IQ. r-.
FILE
12 1
4 d
I
w I
a ,