680172.pdfPOSTED ON KROLL MAP NO.: PERMIT 080 172
BUILDING DEPARTMENT I NUMBER
Applicant Flu
PERMIT APPLICATION Inside Heavy Lines ion ADDRESS i r
NAME (OR NAME OF BUSINESS) a.JL
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JWLAMIAMU
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CITY
NAME 41 t)
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A' Al
=TY
NEW
ADD
ALTER
REPAIR
.,PC
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Four
RESIDENTIAL
A E
21
NON-RESIDENJTIAL
Fj
SIGN
ElDEMOLISH
D
RETAINING
WALL
EXCAVATE
OR FILL
Ej
PENCE
( ........ . x .......... Ft.)
HPRE
,
-MOVE
I..P.
JR[
swim
POOL
DWELLING
UNITS
I hereby acknowledge Mat I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly author-
Ixed agent of the owner. I agree to comply with city and state laws regu.
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
relating to Workmen's compensation Insurance.
NOTE: Permit Limit One Year (Except DE31OLITIONS which
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com-
pleted in nix months.)
31-�,4 $�A, d�l—
N6TE: Applicant Subject to Plan Check Fce
This rermit coven work to be done an private property ONLY.
Any construction on the public domain (curb@, sidewalks, driveways,
marquess, etc.) will require separate permission.
EXISTING STREET R/W
COUP. PLAN ST. R/W ............ IT -
FIRE ZONE I TYPE
0 YES [] NO
[3 YES 13 NO
DEFICIENCY TIUS PROPERTY
to B&nitary sewer
[] YES [-j NO
Setbacks for pool only: Front 151 mine
Side 51 111in,
Rear .5! 111=0
Valuation
Men Check No .......
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
L) 0
Fee
Z
IA
TOTAL AMOUNT DUE I I& (W .1 (413 9-6
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHOIUZES
ONLY THE Signed by the Building Official or Ills Dep-
WORK NOTED uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF DATE
EDMONDS
CZ 5_
PR 0-1107
FILE
. 5
e 1 4