680043.pdf"t, ;
BUILDING DEPARTMENT Applicant Fill
AvInN Inside Heavy Lines
PERMIT APPLICAI
NAME (OR NAME OF BUSINESS)
15rewh6eT +'��
—RAILING ADDRESS
('&CD5 WOT4 :5U)
CITY TELEPHONE NUMBER
L�.YOLJ LL=v UJQ
NAME)
ADDRESS
'50(119 1 —
CITY TELEPHONE NU �ER
NAA
i
01-t - 0/ -
E&RESIDENTIAL
�
GAS
R LINE
NEW
X
F-1 �"
1.
11:1
NO
SIGN
RETAINING
ElDEMOLISH
WALL
ALTER
EXCAVATE
OR FILL
PENCE
I .......... x ......... Ft.)
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
60P�tMUL_j 2�5 uwiT
4?49T
P GOT FE-03CAnT
PROPOSED USE
V, r-101VA
L�
A. I- _11-M S
I hereby acknowledge that I have read this application; that the In-
formation given to 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 Code of the State of Washington
relating to Workman-0 Compensation Insurance.
NOTE: Permit Limit One Year (Except DE31OLITIONS which
pheal be completed In ninety days; MOVED- BUILDINGS shall be eom.
pleted In six months.) T
ER OR AYMNTT_�_� I DATE STNED,
NOTE: APilivifni! S bjejt to Plan Check Fee
F'_ y
7ma re ork to bArollone on VnVVAO property U��X-
Any c1uX=tl:v;t, public domain (curb@, sidewalks, driveways,
. . etc.
marquee , etc.) 1011 require separate permission.
=ED ON KROLL MAL' 14U.: PERMIT
/ e) '? I NUMBER
H ADDRES13
5E YARD 13ET13ACIC I STREET SETBACK
0 YES
N
��B��NG'STREET R/W DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W
REMARKS
0�
Zj /--,S /V
0 YES
Plan Check No.�q�k!
BUILDING
PLUMBING
HEAT & GtEE!2�k.
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
iTOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
FE 0-1107
[3 "S C3 NO
Valuation I Fee I Receipt No.
APPLICATION APPROVAL
This application is not a perniit until
signed by the Building Official or Ws Dep-
uty; and fees are paid, and,receipt is ac-
Imowledged in space provided.
I 1 19 6
Fn
I
0
m
as
let
3-1-LF
a