680068.pdfI
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0
BUILDING DEPARTMENT
PERMIT APPLICATION
LIM
ADDRESS
(804
C
_Q,,�
STATE LICENSE NUMISN"
223 jo I (P A 0 (C.
ption of Property (Show Below or
Applicant Fill
Inside Heavy Lines
Wm Ir
0
7.11560#7W
TN__ KROLL MAP NO.-:-- PERMIT 68U06d
NUMBER
REBS
Cd
0
04
13 YE13 [3 NO
EXISTING STREET R/W ...... ..... FT- DEFICIENCY THIS PROPERTY
C!OMP. PLAN ST. R/W ...... .... X7- .... ....... ITT.
NEW RESIDENTLALL
ADD L NON-RESIDENT!Z�Aj
DEMOLISH
ALTER EXCAVATE
OR FILL
REPAIR PRE'movii;
INSP.
GAB
LINE
SIGN
RETAM,TING
WALL
PENCE
( ........ . x ..........
swim
POOL
YES 0 NO
PLAN CHECKED BY
REMARKS
NUMBER OF
DWELLING
UNITS
R 0 a C) A
Plan Check No ........... ........
PAE-A84
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
22
BEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALT
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVA!RION OR FILL
TOTAL AMOUNT DUE
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.
11 O� Year (Except DE31OLITIONS which
TT:/n!letMe,d
ATTENTION
THIS PERMIT
AUTHORIZES
0114ILY THE
WORK NOTED
!a L91 in Tin days; MOVEDAN BUILDINGS shall be com.
v19651 A sli 4ALbs.) j?yJ
INSPECTION
DEPARTMENT
CITY OF
rjU ;(NER R GE1 T)
DATE SIGNED
EDMONDS
V
A*E: Applicant Subject to Plan Check Fee
PR 6-1107
_i9pPer—mitcovers work to be done on private property ONLY.
Any construction on the Public domain (carbol sidewalks, driveWILY6,
marquees, etc.) will require separate permission.
0 YES 0 No
Valuation Fee
I I
� AAA
,;L. -s—r) 1( &� � (D I
APPLICATION APPROVAL '
This application is not a perinit until
signed by the Building official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
DIRECTOR'S F31GN
S ILTURE
7/T
e , 7
A - D_ 9 -
FILE 6c�l �
Date Pafted
Foundation
Plumbing (Partial)
(Rough)
Frame
Oj
Furnace & Fuel Lines
Final