680369.pdf',�..��'BUILDING
DEPARTMENT
Applicant Fill
PERMIT APPLICATION
Inside Heavy Lines
NAMin (OR NAME OF BUSINESI)
L 6-
- JUITJNG �AMIDRESB
b 06 2
TPEPHONE NUMBER
NAME
-ADDRESS
CITY
TELEPHONE NUMBER
NAME
ADDRESS
6 Fr"") LO
9
E4
CITY
ONE NUMBER
TELEPH -7 1
STATE LICEN13E NUMBER
CITY LICENSE NUM13ER
Legal Description of Property (Show Below or Attach Four Copies)
I
NEW
RESIDENTLI
,,
GAS
LINE
NON-RESIDI TIAL
r_�
SIGN
F� AGO
RETAINING
FJ
WALL
DEMOLISH
ALTER
EXCAVATE
F1
FENCE
Ft.)
OR FILL
( ......... �x . ........
REPAIR
PRE -MOVE
INSP.
E]
swim
POOL
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
UWAIM
PERMIT
NUMBER
680369
IACK BEAR YARD SETBACK
VACANT SITE
[3 YES [3 NO
LEA I VARIANCE INU51OHM 06
- - - - - - - - I -
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT . . ............ IT.
0 YEB 0 NO
Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
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 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 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 PERMIT
relating to Workman's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Your (Except DE51OLITIONS which
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
IGNATURE (0%
INSPECTION
6e
DEPARTMENT
aL.,T
CITY OF
FA %t10
EDMONDS
\j NOTE: Applicant Subject Plan Check Fee
PR 0-1107
This Permit covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways.
caarquees, etc.) wilil require separate permission.
Valuation
Z
W
Cd
[] YES 0 NO
No.
.A, 0
I a, 0,0 N500
APPLICATION APPROVAL &0
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.
KOO A
I
1 4