670415.pdfel
POSTED ON KROLL MAP NO.:
PER IT
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15
BUILDING DEPARTMENT
11—f- FIR
Aj #.-I
NUMBER
J
11F
PERMIT APPLICATION Inside Heavy Lines
eF,7'1� Ar //Cqg I
rroperty (unow kseiow or Attaca irour u
tE!- D I o . 41,4 a
I
GAS
L�J`RESIDENTIAL r_1 LINE
IEl
DADD
N
D SIGN
RETAINING
0
El WALL
DEMOLISH
ElALTER EXCAVATE
FENCE
D OR FILL
El ( x Ft.)
PRE -MOVE
........ . ..........
swim
REPAIR
1:1
INSP.
POOL
VMBER OF STORIES
NUMBER OF
DWELLING
UNITS
rATURE OF WORK T BE DONE
,J-211 7
E�j
KISTING STREET
COMP. PLAN ST.
0 YES
L5
Plan Check No .....................
USE
e��4 BUILDING
PLOT PLAN (indicate Building setbacks, abutting Streeta) PLUMBING
HEAT & GAS LINE
FENCE
30 t SIGN
N
RETAINING WALL
SWIMMING POOL
C),
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in.
formation given In correct; and that I am the owner, or the duly author-
lzod 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 ATTENTION
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT
relatiriff to Workman's Compensation Insurance. AUTHORIZES
ONLY THIE
NOTE: Permit Limit One Your (Except DEMOLITIONS which WORK NOTED
shall be completed in ninety days: MOVED -IN BUILDINGS shall be com-
pleted In six months.) 1_�7
(OWNER JqR�XGENT) DATE SIGNED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6.1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permissi-n.
-or .
q Yr
:A VACANT SITE
13 YES [3 NO
DEFICIENCY THIS PROPERTY
Valuation
I �e ,
YES
Fee
FUI
t
No.
I / gf��l . ey U R a I j I
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.
11 —6Z .1
FILE
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