680039.pdfBUILDING DEPARTMENT APPUCOBtFill
PERMIT APPLICATION Inside Heavy Lines
NAME (on NAIdE OFnUSINESS)
9MIDAPIA I
MAILING ADDREMN
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CITY 3LEPI Jwt
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PHONE I
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BTA&E2L�IiC�ENSE NUBMIS CITY LICENBJ
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I T.i hr Prob-ertvishaw, Below or AtU.Ch Four
Phe S 14 ft cri- tract Lp vii-L-Lowuu.Lu ��
Di__ __ �ogether with that portion of tr�
16 des. as Toll. Beg at a point i4,).o ft
n. of the SE cor of said lot; th W paral'
with the s line to a point on the e TUxTe_
of said lot 209.0 ft n of the s e corner
of said lot; th s 600 ft to the point of
NARU bW1JJAUr- I OkAa-1
EXISTING STREET R/W.--FT-
COUP. PLAN ST. n/w ......... a".
n GAS [3 YES [3 NO
NEW RESIDENTIM I NE PLAN CHECKED BY
N -RESIDEZ IAI, R 8JIG IN
ON �4TLJ4L RETAINING REMARKS
DEMOLISH WALL
ALTER EXCAVATE PENCE
OR FILI, ( .... ..... x ......... 21.)
REPAIR PRE -MOVE SWIM
INSP. POOL
i NUMBER or
DWELLING
J UNITS
-NATURE OF WORK TO BE DONE
A&V A66� -A ;,;12� 13
Met Check NO.
in "I
-FR—OPOSED USE BUILDING
PLOT PLAN (IndFaite, Building setbacks. abutting streets) PLUMBING
04
HEAT & GAS I=
LA� :B4 gig— PENCE
SIGN
ACD�J
e RETAINING WALL
MrNG POOL
SWIM
DEMOLITION
PRE.MOVE INSPECTION
EXCAVATION OR FILL
Aew5lsoi CA/ 6XJ5JrPV&-b
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the III -
formation given in correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply With City and state law$ rCgU" ATTENTION
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 THIS PERMIT
relating to Workmen`$ COmPeast-tiOn Insurance- AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DE31OMTIONS which WORK NOTED
shalt be completed in ninety days; MOVED -IN BUILDINGS shall be Com-
pleted Ilk six months.)
T GE DATE MOVED INSPECTION
C!;, 1097 DEPARTMENT
Crry OF
EDMONDS
NOTE: Applicant Subject to Plan Check- Fee PR 6-1107
This permit covers work to be done onPrivate property ONLY -
Any construction on the public demean (curbso sidewalks, driveways,
marquees, etc.) wILI require separate permission.
VACANT _EHTE
El YES r] NO
VA'RIANCM NUMBEK—
DEFICIENCY THIS PROPERTY
2
0 YES E3 I -TO
1 3--� -ro ri
No.
APPLICATION APPROVAL
This application is not a pernift until
signed by the Building Off Wal or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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