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11BUILDING DEPARTMEINH Applicant F111
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ION Inside Heavy Lines —jGSAy
PERMIT APPLICATION
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or
DNEW
RESIDENTIAL
GAS
LINE
1:1
UI
NON-RESIDENTIAL
SIGN
DADD
RETAINING
nDEMOLISH
WALL
ALTER
D
EXCAVATE
OR FILL
PENCE
G x Ft.)
El REPAIR
F-1
PRE -MOVE
INSP.
......... ..........
swim
POOL
ES
NUMBER OF
DWELLING
UNITS
ILD SETBACK
k- 1 1 1, - I
1
4
PERMIT
NUMBER bbUU11
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[3 NO
UMPPR
EXISTING I STREET R/W .... ....... FT- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ....... ... XT.
[] YES [3 NO
Plan Check No ............ . .......
PROPOSED UBE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given In 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 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 Washlugton
THIS PERMIT
relating to Workman's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Umit One Year (Except DEIMOLITIONS which
WORK NOTED
shall be completed In ninety days: MOVED -IN BUILDINGS shall be Core.
Pleted in six months.)
SIGNATURE (OWNER R DATE SIGNED
INSPECTION
rGENW)
L4
DEPARTMENT
I
CITY OF
mr-
EDMONDS
NOTE: Applicant Subject to Plait Check Fee
PR 6-1107
This Permit coven work to be done on Private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) win require separate permission.
[:] YES 0 NO
Valuation I Fee
No.
FA
W-W-41MIG&M
APPLICATION APPROVAL
This application to not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
Lc�
PH
- - ---- - ------
PLAT OF,'SURVEY FOR: M. A. QUARNSTROM
DED IN VOLUME 14 OF
LOT 16, HAWARDEN TRACTS, ACCORDING TO THE PLAT THEREOF RECOR
or SNOHOMISH COUNTY, WASHINGTON-
PLATS, ON PAGE 69, RECORDS
SCALE: I" = 40 FEET
NOVEMBER 25, 1967
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FILE NO. 3441
FB 234/51
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