670315.pdf11
BUILDING DEPARTMENT
PERMIT APPLICATION
NAM (OR NAME OF BUSINESS)
L—Aa-9-1 F % c44ir� iS M-oJ
—MAILING ADDRESS
CITY
PL32-01 4 4 At V'C— 17
F I c4e— ff-d
or
POSTED ON KROLL MAP NO.: PERMIT
Applicant M //300 NUMBER
Inside Heavy Lines �JUBADDREHS I&
9LO 4'a / — 96
SIDE YJRD SETBACK I STREET SETBAUK
1) —1 r#Ajr- gLijO4:S
AJ W r—"r L_d) _r
ISO(*
19NEW RESIDENTIAL
NON-RESIDENTIAL 1
DADD
DEMOLISH
DALTER EXCAVATE
D OR FULL
REPAIR PRE -MOVE
1:1 INSP.
D
0
GAS
LINE
SIGN
RETAINING
WALL
PENCE
( .......... x .......... Ft.)
swim
POOL
;UMBER OF STORIES
NUMBEK VF
DWELLING
UNITS
qATURE OF WORK TO BE DONE
AJ E_ L4-.-$
14 0 t1 0,
670315
/.�r I / . 111 % t
VACANT SITE
[] YES [3 NO
PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W.��PrT. DEFICTMCY THIS PROPERTY
COMP. PLAN ST. R/W 6.0-FT. ... !9 ... X7.
ft
I= ZO
3
SPECIAL
Ej YES
14
OF
Plan Check No ......... ...........
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
BEAT & GAS LINE
PENCE
-7
t SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR PILL
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
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 PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE. Permit Limit One Year (Except DEMOLITION'S which WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
IIGNATURE (OWNER OR AGENT) DAT' SIGNE INSPECTION
DEPARTMENT
7� CITY OF
EDMONDS
NOTE: Applicant SubJect to Plait Check Fee PR 6-1107
-ilile Permit covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks. driveways,
marquees, etc.) will require separate permission.
[6M
[] YES 0 NO
Fee
2 3j F,5/40 _I Z 2,S_6
'/�' 0 0.
A crr. r-
No.
r,VAWR��
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.
FILE
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