680100.pdfI A
BUILDING DEPARTMENT
PERMIT APPLICATION
NAMM (OR NAME OF BUSINESS)
Applicant Fill
Inside Heavy Lines
CITY NUMBER
NAME
ADDRESS
A/7 (f ��
C;t.3 - tq I-
iow'Sekiw or Attaca your uol
�� e� "97 \/
P No.: PERMIT
I NUMBER
680 ! n_0
TETBACKC
SIDEtY ARD SETBACK
r7
5TIMbir EjErBACK REAR V;UiD
' r j
S- 1
k
1-h
'2
M 0
.
USTI
J�UT AREA
..
42r
I
[3 YES NO
I VAIUANG19 141) IBEA
cixx�mx a-/ " �C/P'
E2138TING STREET R/W .... e:-- FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/WA:�?M'
RESIDENTIAL
L�j
LINE,
ADD
IDENTIAL
E]
SIGI.T
RETAINING
El
WALL
DEMOLISH
EXCAVATE
PENCE
ALTER
OR FILL
El
( ........ . X .......... Ft.)
REPAIR PRE -MOVE
INSP.
swim
POOL
NUMBER OF STORIES
NUMISEM UF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
eee- 14/ Hit V ez -P—,
I
TYPE
Lk
[3 YES [3 NO I _T
2
Plan Check No .....................
PROPOSED USE
45_115�. '7
BUILDING
/
-PLOT
Q (Indicate Building setbaclis, abutting streets)
PLUMBING
HEAT & GAS LINE
4-
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
0
DEMOLITION
V
I
PRE -MOVE INSPECTION
EXCAVATION 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-
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 PEUMIT
rolatIng to Workmenlo Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONIly THE
WORK NOTED
C,uUl be completed In ninety days; M0VED-XN BUILDINGS shall be com-
pleted In six months.)
SIG;N73 (OWNER OR AGENT) DATE SIGNE
INSPECTION
DEPARTMENT
�7
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
This Permit covers work to be done on private Property ONLY.
Any construction on the pubtle domain (curbs, sidewalks, driveways,
courquees, etc.) win require separate permission.
STREET IMPROVED
13 YES 0 NO
Valuation Fee Receipt No.
0
Qc
i0c 01V
7A.To I 4W30si
APPLICATION APPROVAL
TMs application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
lmowledged in space provided.
DZ7BIG
_lei
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