680164.pdfI
BUILDING DEPARTMENT Applicant inn
PERMIT APPLICATION Indde Heavy 'Anes
NAM[M (01% NAXM OF —BUSINESS)
MAIIAING ADDRESS
�2 2- /0 6611
CITY
V�A/d Ald�� 17�76 7X 15
NAME Al
ADDRESS
CITY TELEPHONE NUMBER
HAAM
0,+A'o
ADDRESS
'-fE—LEPHONE NUMBER
CITY
I/W 'yo
-1 CITY LICENSE NUMBER
SWATE I'LUMNAMS MAMMA
19- 3 - 6 / / 1/ 9- 1/
C n'),
NUMBER 6801164 1
ON KROLL 31" NO., PE
DRESS
Fj* , � /
v
�A�RDS BACK STREET SETBACK RmAR, TARD SETBACK
I h) ilvd. ;z S ' 777 ;2 V 49 1 1 0
or 1.4 LOT AREA vAUAnW DAIKAW
'3�N RIJILDINC X!! 8 Cin C3 NO
EXISTING I STREET R/W DEFICIENCY THIS PROPERTY
..._ r.
COUP. PLAN ST. R/W ... ....... XT. ...... PT.
indicated on Standard Drawing #103.
13 YES 0 NO
RESIDENTIAL
NEW
NOX-RESIDENTIAL !G:
RETAINING
DEMOLISH WALL
E] ALTER EXCAVATE PENCE
on FILL El ( ........ . x . ....... Pt.)
REPAIR PRE -MOVE swim
INSP. POOL
ANO
011CILECKED
P BY
REMARKS
NUMBER OF STORIES__
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO 33E _DONE
Plan Check No ............. ... ...
Valuation
Foe
Receipt No.
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building Setbacks, abutting
(0
strIata)-,
t
N
BEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
T;�c ae
I hereby adenowledge that I have read this application; that the in-
formation given In correct; and that I am the owner, or the duly author -
lead agent of the owner. I agree to comply with city and State laws regU-
letting 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 WorkineWs Compensation Insurance.
NOTE: Permit Umit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED4N BULLBINGS Shell be ODM-
plated In XLX months.)
ATTENTION
TM8 PERMT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pill 6.11"
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-
knowledged in space provided.
SIGNATURE (OWNER OR AGENT)
DATE SIGNED
�14 6;
a ZIG-
DATE
NOTE: Applicant Subject to Plan Check Fee
This Pernall c0vG111 work to be done an private property ONLY.
Any consignation an the pubtle domain (curbs, sidewalks, driveways.
marquees, CU.) win require separate permission.
PILIR
r
A3110MA TO APPL ICATION FOR BUILDING PERMIT
MAL DESCRIPTIONS
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