680001.pdfPOSTED ON KROT
3
BUILDING DEPARTMENT Applicant M
PERMIT APPLICATION Inside Heavy Lines j5B
NAMM (OR NAMM OF BUSINESS)
BID]
CITY TELE ONE NUMBER
6
14AM
ADDREBS
M901
EX
CITY
TE-LEPHONE NUMBER
c
RE
NAMM
117e6
ADORES S
CITY
YELEPHONE NUMBER
Itle. Z - �1�4r ot_5 bu
STATE LICENSE NUMBER
CITY LICENBlu NuAdJ341t
49
1
Legal Description Of Property (Show Below Attach Four Copies)
Z
PI
_RI
44
GAS 13
F1 RESIDENTIAL LINE
P:
NEW
NON-RESMENTIAL SIGN
RETAINING
WALL
DEMOLISH
ALTER EXCAVATE FENCE
( x Ft.)
OR FILL ........ . .. .......
REPAIR PRE -MOVE SWIM
INSP. POOL
NUM13ER OF
DWELLING
UNITS
NATURE OF WORK WU Lim
1?e 2E&, e r1re 2< 4V-,7 lr-;-
;-A
PROPOSED UBN
PLOT PLAN (indicate Building setbacks. abutting streets)
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-
ized 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
will be employed in violation of the Labor Coda of the State of Washington
relaUnir to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be core.
pleted In six Months.)
SIGNATURE (OWNER OR AGENT)
DAT9 SIGNED
Ve
NOTE: APPlicant Subject to Plan Check Fee
This Permit covers work to be done on private Pr*Pcrt' ONLY -
Any construction on the public domain (curb$, sidewalks, driveways,
marquees, etc.) win require nefigmte permission-
ADDREBB
PERMIT
NUMBER
680001
CK
AR YARD TETBACK
S
Z
ANT ITE
.CANT STE
YES [3 No
NOE NUMBER
[STING STREET R/W DEFICIENCY THIS PROPERTY
OMP. PLAN ST. R/W ....... ... JPT- ..........
YES 13 NO
:AAN CHECKED BY
EMARKS
Ian Check No....
UILDING
ILUMBING
MAT & GAS LINE
PENCE
3IGN
EMTAINING WALL
3WIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTEIMON
THIS PERMT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
Valuation
rA
I
E3 YES 13 NO
.3, C 0 1 (4-1 qS
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or Ws Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
ANNEEMENE
iWWUP, 4
r
I W.
1 4 p
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I L