670437.pdf�A
POSTED ON KROLL MAP NO.: PERMIT
BUILDING
DEPART ENT Applicant F111
'c:uryr'
NUMBER
._-A.- 437
PERMIT
es
Inside 171cavy Lines
APPLICATI N
JOB ADDRESS ek C:�
NAME (OR NAM OF BUSINESS)
AW
SIDE RD SETBACK STREET SETBACK REAR YAR D SETBACK
Y�,
1 ;L1 �� w MAILING ADDRE1313 I -) 1 -2 5 FYI i Nf / D 0 1
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El NEW
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ALTER
REPAIR
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LrRESIDENTIAL
R
GAS CVA%'5V
LINE
NON-RESIDENTIAL 1
0
SIGN
0
DEMOLISH
RETAINING
WALL
EXCAVATE
PENCE
OR FILL
( .......... x .......... Ft.)
PRE -MOVE
swim
INSP.
POOL
DWELLING
UNITS
; STREET R/W ........... FT.
PLAN ST. R/W ............ FT.
TYPE OF
[3 YES 0_9�0
a
Plan Check No ................ . ...
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
I
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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-
Ized agent at the owner. I agree to comply with city and state laws regu-
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Vimit One Year (Except DE41OLITIONS which
shall be completed In ninety days; MOVED -IN BUILDIIGS shall be com-
pletedA six m0_q1JuQ,
NOTE: Applicant Si4eqt to Plan Cbeck Fee
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 Permission.
TOTAL A31OUNT DUE
[3 YES
NO
UMBER N
DEFICIENCY THIS PROPERTY
Valuation
[] YES [:3 NO
Fee
P
Z
FA L
No.
ATTENTION I APPLICATION APPROVAL �
THIS PERMIT This application Is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, find receipt is ac-
I knowledged in space provided.
INSPECTION DIRECTOIL'S SIONATURY,
DEPARTMENT
CITY OF 4
EDMONDS DATE
PR 0-1107
FILE
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