680036.pdfju
0 DEPARTMENT
APPLICATION
z or BUSIN11311)
k.4 .
-71' se
Applicant FM
Tnalde Heavy Lines
, 8 - I Z' r27
ADDRESS
2—
19reC-A)&Q6d �9Q&—
14J
cm
TELEPHONE
NUMBER
Sew oy/c
S�W-
d'26
ITAT11
CITY
LICENSE NUMBER
jl�
PtIOn of Property (Show Below or Attach Four Copies)
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RESIDENTIAL
NE,
V
AD!
)�
I NON-RESIDENTIAL
RETAnirNG
WALL
DEMOLISH
EXCAVATE
PENCE
AI1.7ER
OR PILL
Pt.)
RE?AIR
PRE -MOVE
El INSP.
. ........
swim
D POOL
NUMBER )P STORIEF1'_
NUMBER or
DWELLING
I
UNITS
PERMIT
NUMBER
680036
13 YES
SETBACK
I
E3 NO
UMBER
EXISTING STREET DEFICIENCY TM13 PROPERTY
[I YES E3 NO
Plan Check No ..............
PROPOSED USE
BUILDING
PLOT Buildiii-eiRb—acks, ib-utting streets)
PLUMBING
AQ
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWnfXMG POOL
DEHOLITION
PRE -MOVE INSPECT70N
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I here�Y acknowledge that I have read 099 application; Mat MG In-
formation Oven In correct; and that I am the owner, or the duty author -
lead agent a the owner. I agree to comply with city and state laws reffu-
ATTENTION
lating construction; And in doing the work authorixed thereby, no person
will be ernPI)yed In violation of the Labor Code of the State of Washington
TWO PE193M
relating to Workmens Compensation Insurance.
AUTHORIZES
NOTE: Fermit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVzD-IN BUILDINGS shall b6 core.
PIC!" six m9ths-k
�(UWNE OR AG ATE SIGNED
85ONAYURB BNT) D
INSPECTION
DEPARTMENT
(�D
orry OF
EDMONDS
NqrE: APPU'cant Subject to Plan Check Fee
PH 6-1107
This Pa"t coven work to be done on Private property ONLY.
Any construction on the public domain (eurbs, oldewsuLs, driveways,
I marquees, age.) win require sep"Ite Permission.
13 YES 13 NO
Fee
APPLICATION APPROVAL
No.
This application is not a permit until
signed by the Building Official or Ids Dep-
uty; and fees are paid, and receipt is ac-
knowledged In space provided.
10 — 10 0
FILE �z
9