680067.pdfa
F0�13TEDON KROLL MAP NO.: PERMIT
.",..BUILDING DEPARTMENT Applicant FIU M.E.
Inside Heavy Lines EBB
PERMIT APPLICATION I _9�1
NAME (OR NAME OF BU Ll W
SINESS)
SETBACK ST1179ET SETBACK
SIDE YARD
NO ADDREBt J VAC
TELEPHONE NUMBIfR
NAME
ADDRESS
CITY I �TELEPHONE NUMBER
NAME
_WD—DRES8
J
CITY .�..�_NENUMBER
STATE LICENSM MBER CITY LICENSE NUMBER
Legal Description oF—Froperty (Show Below or -Attach Four Copies)
Z
0
'z
NEW
ADD
ALTER
REPAIR
GAS
El RESIDENTIAL LINE
NON-RESIDENTL&L E-1 SIGN
j RETAINING
ODEMOLISH r_1 WALL
rm EXCAVATE PENCE
OR FULL El ( .......... x .......... Ft.)
F-1 PRE -MOVE swim
INSP. 1-1 POOL
DWELLING
UNITS
t
N
I
YES 0 NO
HEIGHT BUILDING AREA
VARIANCE NUMBER
r.
PLOT PLAN APPROVED
STREET R/W
DEFICIENCY THIS PROPERTY
EXISTING STREET R/W ............ PT.
COMP. PLAN ST. R/W ............ FT -
FT.
REMARKS
;r
�By
'ICIIECRED
ME C, CHECKED BY
04
REMARKS
TYPE CONNECTION
VERIFIED BY
PERC. TEBW
PERMIT NUMBEIt
REMARKS
FIRE —ZONE TYPE OF CONSTRUCTION STREET IMPROVED
[3 YES E] NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
YES [] NO
PLAN CHECKED BY
I hereby acknowledge that I have read this application; 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 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 Workmen's Compensation Insurance.
NOTE: Permit Umit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be corn
Dleted-M six mooM A
E: APPlicant Sitbject to Plan Check Fee
This Permit covers work to be done on private Property 0141,x-
Any construction on the public domain (curbs, sidewalks, drivewava,
marquees, etc.) will require separate permission.
REMARKS
Plan Check No .....
BUILDING
PLUMBING
BEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE_hlOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1101
Valuation
Fee
� C) rj
No.
I A.0 C) lk+�L440
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged In space provided.
" �7/— �
I?— & — b 1�1
FILE
riUlISLJIIJS JVQI U011
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