670342.pdfB U, WING DEPARTMENT
PERMIT APPLICATION
N (0 USINESS)
MAILING ADDRESS
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CITY
NAME
ADDRESS
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60M QS
NAJ" t
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ADDRESS
CITY
Applicant Fill
Inside HeRvY Lines
RESIDFNTIA
0
GAS
LINE
NEW
NON-RESIDT TIAL
SIGN
RETAINING
F1
WALL
ALTER
DEMOLISH
EXCAVATE
OR FILL
PENCE
( x Ft.)
.......... .........
REPAIR
PRE -MOVE
INSP.
swim
POOL
ES
NUMBER or
DWELLING
UNITS
20
IN KROLL MAP No.: PERMIT
I NUMBER Q
t—D SETBACK STREET SETBACK REAR 7
/,.f I /V1 'A01,
rE LOT AREA
4v� YES
'BUrJEMNG AREA VA—RIAP
'Ira
[law
; STREET R/W
PLAN ST. R/W
-71 If 1 .2� 1 t
13 YES
I
& 40 Plan Check
PROPOSED UBE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets) PLUMBING
BEAT & GAS LINE
6491 FENCE
SIGN
t
N
IRETAINING WALL
SWIMMING POOL
k 1*7
0 DEMOLITION
J!J 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-
Ixed agent of the owner. I agree to comply with city and state laws regu- ATTENTION
lating construction; and in doing the work autharized thereby, no person
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT
relating to workmen -a compensation insurance. AUTHOIRZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
Ahan be completed In ninety days; MOVED -IN SUIT NOS $hall be com-
pleted In all months.)
IIGNATURE (OWNER OR AGENT) DAT E INSPECTION
DEPARTMENT
WaM4,mj jk~20. Crry OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This permit covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquess, etc.) win require separate Permission.
DEFICIENCY THIS PROPERTY
0
-BY4
az
1-910D
'ID
0 YES e4o
Valuation Fee
—LIZ �-o 0
No. I
1 14.3 1. *7$13 ?o 4
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt to ac-
knowledged In space provided.
FILE
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