680088.pdfi
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
.9,4cl< EEQ�yd�eal)s
MAILING ADDRESS
/Yd 2 - Al- ;Z a S
CITY TELEPHONE NUMB119
scrIption of Property (Show Below or Attach Four 1
- y _A j AL a F 4 a � / / a
C
NEW
RESIDENTIAL
GAS
LINE
1:1
r,
NON-RESIDENTIAL JF�
ADD
SIGN
RETAnsaNa
DEMOLISH
WALL
EXCAVATE
PENCE
ALTER
El OR FILL
( x Ft.)
REPAIR PRE -MOVE
W INSP.
El
........ . ..........
SWIM
POOL
NUMBER OF 13TORIES
NU 6F_
iosea .oyjp
DXXf
UNITS No
P NO.:
. ;4- 0
EXISTING STREET n/w ... ....... xv
E] YES
El NO
Plan Check No ................. ...
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In-
formation given to correct; and that I am the owner, or the duly author-
Imed agent of the owner. I agree to comply With City and state laws rC911-
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 PERBUT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
aball be completed In ninety days; AIOVED-XN BUILDINGS shall be Coal-
pleted in six months.)
IGVATURE�WWNEH
OR AGENT)
DATE SIGNED
INSPECTION
14e
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PH 6-1107
This Permit Covers work to be done an private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate peraduslon.
PER.%IIT
NUMBER 680088
ikMl 114
13 YES 13 NO
DEFICIENCY TH113 PROPERTY
............ FT .
Valuation
[] YES 13 NO
Fee
o 10
No.
9-0 Z 14--Xila"
APPLICATION APPROVAL
This application is not a permit until
Signed by tile Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Itnowledged in space provided.
13 13
C , �XXU_x.,&41
— 0
FILE