670328.pdfBUILDING DEPARTMENT
Applicant F111
Inside Heavy Lines
PERMIT APPLICATION
NAME (OR. NAMM OF BUBINE116)
L
Rid Joe- 4't=
MAILING ADDRESS
_k'A Qr, /
Al a
12- Ca
CITY J�gl NUM13ER
STATE LICENSE NUMBER CITY LICENSE NUMBER
Legal Description Of Property (Show Below or Attach copies)
ElNEW 0 RESIDENTIAL =E;
ElNON-RESIDEN77AL ;SIGN
F] �� RETAINING
nDEMOLISH WALL
ALTER EXCAVATE PENCE
n OR FILL ( ......... �X . ........ Ft.)
REPAIR PRE -MOVE swim
1:1 INSP. 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 construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
relating to WorkmeWs Compensation Insurance.
NOTE: Permit Umit One Your (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS oball be com-
pleted in SIX months-)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers Work to be done no private Property ONLY.
Any construction an the public domain (Cnrbs, aldewalk@, driveways,
marquees, etc.) will require separate permission.
CM—HROLL MAP NO-: PERMIT
NUMBER
FtESS
/a
RD SEMBACK STREET SETBACK
qE LOT AREA
8 1 -Ls
EXUITING STREET R/W .......... ST.
COMP. PLAN ST. R/W ........... An.
13 YES 0 NO
e�
Plan Check No .......
L-1"L_'jRUf
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR PILL
TOTAL AMOUNT DUE
ATMNTION
THIS PERMIT
AUTHORIZ
ONLY TEEM
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
670328
IAR YARD SETBACK
�CANT SIT111
YES 13 NO
�M"_Clll NUMBER
DEPICIENCY THIS PROPERTY
Valuation
[3 YES
0
No.
I - i>. C9 4 1 ;5-06 9 %
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-
Imowledged in space provided.
DATJ@e��Z
FILE