670347.pdf........ .. . ..... ...... - - - - - - - - - - - - -
POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT =AppUcant Fill, NUMBER 67C
Its
Inside Heavy Lines
PERMIT APPLICATION i
Sa
CITY
NAME
6 W N -e v—
'� e- e- - lor /,9 Twp-
— 4:_
eer Aoirtlztf 7XN 003?eaj�Fgl
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iF j.9 il L) j- N 7A 4F /7 5—. ils� V ZA
NEW
RESIDENTIAL
GAS
LINE
Lg�.N�ON-RESIDENTIAL
SIGN
ADD
Pol"ALTER
ElDEMOLISH
RETAINING
D WALL
D
EXCAVATE
on FILL
PENCE
( x Ft.)
REPAIR
n
PRE -MOVE
INSP.
.......... ..........
SWIM
POOL
NUMBER OF STORI
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
VACANT SITE
[3 YES 0 NO
VA—RIANCF, NUMBER
EXIST'ING'STRF,LT R/W ............ FT- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ........... 1". 1
REMARKS 199
CKSD BY 0
z
_7 1 ;4
METER S� E ICLEARANCE I CHECKEI) BY
IMM—ARKS
0 YES (:] NO
or
Plan Check No .....................
PROPOSED
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A3JOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I ara 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 Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com-
pleted in six months.) /7
49R OR AGE DATE SIGNED
?Y'
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PH 6-1101
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
rnarqueest etc,) will require separate permission,
Valuation
STREET IMPROVI
[] YES [] I-ro
Fee
APPLICATION APPROVAL
I
M
No.
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.
. '7;' �
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