680145.pdf- -----------
POSTED ON KROLL MAP NO.: PERMIT
ER
N� BUILDING DEPARiMiT NUMB
Inside Heavy Lines JOB ADDRESS -4.7 �� 0
PERMIT APPLICA —1 / I/ I / _��
13 YES
500 a ff "I E 17- M W "Ll
:O:N:O :j
UMBER I
STREET R1W
EXISTING STREET R/W ........... FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT- ........ ... 0
CTfy-
TELEPHONE UUBER
REM.ARXB
W
NAM
owk)
JOURESS
or
O.Aj
�C jt�(, CIMAWrt,
NEW
1
D-SESIDENTIAL
El
GAS
LINE
2eADD
1:1 NON-IIIESIDENTIAL
SIGN
RETAINING
FDEMOLISH
WALL
ALTER
M
EXCAVATE
On FILL
PENCE
( .......... x ..........
REPAIR PRE -MOVE
El INSP.
swim
POOL
IUMBER OF STORIES
NUMBER or
DWELLING
UNITS
PERC. TEST PERMIT NUMBER
REMARKS
0 YES
[] NO
Z
_�
/--C>if
Plan Check No ................. ...
PROPOSED USE
'Fee,eewnwu
BUILDING
J?bQ---n
_NL_OT
PLAN (Indicate Building setbacks, abutting streets)
PLX13MNG
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I hove 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 regu-
t
ATTENTION
construction; and In doing the work authorized thereby. no person
will be employed In violation Of the Labor Code of the State of Washington
w,
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZM
ONLY TIEE
�l
NOTE: Permit Cimit One Year (Except DEMOLITIONS which
WORK NOTED
[lat'Ing
a 'ib -IN BUILDINGS shall be com-
beat be completed in ninety days: MOVED
leted in six months.)
p Ph
INSPECTION
SIONXTUR)y (OWNER U DATE BIG NED
IC
DEPARTMENT
_1414
CITY OF
EDMONDS
NOTE: Applicant Snbjecl to Plat; Check Fee
PR 6-1107
This Permit coven work to be done on private Property ONLY.
Any construction on the public domAJA (curbs. sidewalks, drlvewaYs,
marquees, etc.) win require separate permission.
0 YES 0 NO
Fee
.3. V
Receipt No.
I a - 0 6 V#;MS
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.
FILE
I
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