670591.pdfBUILDING DEPARTMENT I Applicant Oil
PERMIT APPLICATION Inside Heavy Lines
NAME (Olt N&ME OF BUSINESS)
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MAJEsING "DRESS
CITY TELEPHONE NUMBER
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NAME
ADDREIISI
liell�4-oE5 7
CITY TELEPHONE NUAT
1,PPt? J 73
NAMAO 4
ADDRESW
/9//V-9 7
CITY TELEPHONE NUMBER
Y-1 7 3 7
STA LICENSE NUMBER CITY LICENSE, NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
.46 2 IS Hr7"Ls
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NEW RESIDENTIAL I
NON-RESIDENTIAL
0 ADD
DEMOLISH
0 ALTER EXCAVATE
OR FULL
REPAIR PRE -MOVE
El INSP.
R
F-1
= E
SIGN
RETAINING
WALL
PENCE
( ........ . x .......... Ft.)
swim
POOL
r'R OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
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ON KROLL At" vu'; PERMIT 670591
/9/)6, 1 NUMBER
DRESS
. 0 / � — / 7- / '-�16
ARD SETBACK STREET SETBACK REAR YARD SETBJ
1 01 z— 1 J,3.- 0 , 1 -1 Z- ( /-I,, - 0
EXISTING STREET R/W
COMP. PLAN ST. R/W ............ Pr.
2#11, 1 -yq- C ,
[] YES
0 NO
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0
Plan Check No .................
PROPOSED U13E
BUILDING
94
PLOT PLAN (Ind 0, abutting streets)
PLUMBING
C4
0
ft
HEAT & GAS LINE
FE!ICE
SIGN
RETAINING WALL
otoc 7'0-
SWIMMING POOL
DEMOLITION
PRE -MOVE -INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this ft])DUCation; 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 Willi city and state laws regu-
ATTE NTION
latlng construction; and In doing the work authorized thereby, no Person
will be employed in violation Of the Labor Code of the State of Washington
Tins PERMIT
relating to Workmen's Compensation Insurance.
AUTHOIUZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall lye completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NATURE (OWNER OR AGENT; DATE 81GNED
INSPECTION
-6-7
DEPARTMENT
=Mlm
CITY OF
UM
r
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Perron covers work to be done an private property ONLY.
Amy construction On the public dGmaln (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
(3 YES [:] NO
DEFICIENCY THIS PROPERTY
........ ... FT.
Valuation I Fee
FM
Z
W
No.
I q1' eg i 4a� '
APPLICATION APPROVAL
This application is not a pern-lit until
signed by the Building Off icial or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE