670365.pdfCd
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION inside Heavy Lines
I NAhn (OR NAME
BUSINESS)
% I
ll!rLj
IREBS
01.3 1
LRD SETBACI
0.: PERMIT
NUMBER 67036
REET SETBACK REAR YARD BE'
I % I I %
AS MIM /5 rv\lq 0
C] NO
UMBER
[3 YES
x SWILEVK k&IW 4�0
TELEPHONE NUMBER EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY 0
COUP. PLAN ST. R/W ..6.0.FT.
REMARKS
Milk
CHECKED BY
METER SIZE I SERVICE SIZE CLEARANCE CHECICIM BY
TELEPHONE NUMBER -1// 1,
_401 F,02,77- 40 REMARKS
ATM LICENSE NUMBER CITY LICENSE NUMB R
23-01- 10F&_1 TYPE CONNECTION VERIFIED BY
gal Description of Property (Show Below or Attach Four Copies) I
%4, av&"e A2 15� a j PERO. TEST PERMIT NUMBER
7�34�
I/ t I :a
Y', .71 "// /Z, <,007 - fy'/Z /,/0 1 M
; 0 M we �11 71 - �12
1 Ej YES
2--NEW
[�RESIDENTIAL
17
GAS
LINE
DADD
1:1
NON-RESIDENTIAL
F I
SIGN
RETAINING
ElDEMOLISH
1-1
WALL
F1ALTER
EXCAVATE
PENCE
El OR FILL
( x Ft.)
REPAIR
PRE -MOVE
1:1 INSP.
........ . ..........
swim
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
E] NO
Plan Check No ............ . .......
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Bull setbacks, abutting streets)
HEAT & GAS LINE
6 P-3
PENCE
t
SIGN
N
RETAINING WALL
Ci
ID
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
�tgiapp_ icatoW,
TOTAL AMOUNT DUE
I hereby acknow. gaiat I have reE 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-
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
TIUS PERMIT
relating to Workmens Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
IIGNPAURE (OWNER_OR AGENT) DATE TI—GNED
INSPECTION
/. I
DEPARTMENT
'A
CITY OF
EDMONDS
NOTE: Applicant goit4b�ject to Plait Check Fcc
PR 6-1107
TWO permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewayn,
marquees, etc.) will require separate permission.
Valuation
Fee I Receint No.
1 7 V. S__0 I
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.
DATE
87 — c�-7 —
FILE F,
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