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POd'l'ffiD ON KROLL MAP NO.: I rPII,�>� b70337
BUILDING DEPARTMENT AppllcantFill
PERMIT APPLICATION InBide Hoavy Ltnee IOp /��R�� I��t�i�YV'�YJ 1. _I � � 1
� NAMH,IOR NAME OS ljUBINEBB)Xr 14 w� _ I,.LP'w
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STATE LIOffiNBffi NU ER CITY LICENSE NU A
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LegN DeecrlDtton of Property (Sh w Below or Attach Four Copfee)
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RESIDENTIAL O IO.IADSIE
❑ NEW � NON•REBIDENTIAI.
BION
❑ ADD � DEMOLISH O ww �NIN6
ALTER ❑ EXCA�V� ❑ �NCx..........Ft.)
.REPAIR PRE•MOVE M
INSP. POOL
NUMBER OS STORIES I NUMBER OF
DWELLING
UNITS
� Cf� IV � � � UC'�I-I C7 • — Ptan Check NO..._..».._.�..
PROPOSED UBffi
BUILDING
ii PLOT PLAN (Imllcate Sulldlag eotbacke, obutting attests) pLV3IBIN6
C!
� HEAT h 6A8 LINE
FENCE
BION
N
RETAINING WALL
8W1TSMnV6 POOL
DEMOLTTION
PRE•MOVE INSPECTION
EXOAVATION OR FILL
TOTAL A3fOUNT DUE
I hereby acknowledge that I hnve teed lhls apDllraUon; that the fa-
formaUoa given le correct; and that I nm the owner, or rho duly nulhor-
Ised agent of the owner. I agree to comply with city end elate laws raga- ATTENTION
IaUa6 wastructloa; and 1n QMnH the work authorised Wereby, no person
will be employed to vlolntloa of the Labor Code of the State of Waehlagton TEiIS PERMIT
relating to Workmen's Compeaeatloa Imutmca. AVTIIORIZES
ONLY THE
NOTE: Permit Limit One Year cEsreDt DE�fOLITIONB n•hlch IcoRH xoTEa
shall Lx completed to ninety days; >+tOVED-IN BOILDIN08 aluW be com-
pleted In elz months.)
d ONATURE (OWNffi O AOffiNT) DATE BIONED INSPECTION
% _ L DEPARTMENT
�/ � —I� CITY OF
EDMONDS
NOTE: Applicant Subject to Plan CGeck Fee pR 8-1307
Thle Pettnit corers work to be done oo prlvnte property ONLY.
Aay conetractloo oa the DabUc domnla (enrbe, sldewdlu, drlvewoye,
marquees, ale.) wla reQalre separate permission.
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�VERIFIffiD BY i.�
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PERMIT NUMBER � 1 `,
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781'RVCTION STREET IMPROVED I •'
0 YffiS � NO � � �. ,�•4 �
iED I OCCUPANOY GROUP � �, .
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APPLICATION APPROVAL � .
This application 1s not a permit until � '�
signed by the Building Official or his Dep- � � �
uty; and fees are paid, and receipt fa ac- � {
]rnowledged in space provided.
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