680385.pdflot
q U-ILWING DEPARTMENT Applicant F111
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In
im IT APPLICATION Inside Heavy Lines
NAME (Oir'ZIAME OF BUSINESS)
D 0 At 4 ID Gr Vn U G-19 7—
�Nll ADDRESS
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1 7 1 #-4
C3 --TELEPHONE NUM13MR
75�97
NAME
TELEPHONE NUMBER
NAME
ADDRESS
CITY TEERPHONE NUMBER
8
STATE LICENSE NUMBER CITY LICENSE NUMBER
JASW Description of Property (Show Below oj� Attach Four Copies)
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NEW
El RESIDENTU
GAS
LINE
NON -RESIDE TIAL
SIGN
RETAINING
0
EJ
WALL
DEMOLISH
0 ALTER
n
EXCAVATE
OR FILL
PENCE
( x Ft.)
.......... ..........
REPAIR
El
PRE -MOVE
INSP.
SWIM
POOL_
NUMBER OF
DIVELLING,
6
UNITS
A./ J� U) jv-C �-
11 KROLL MAP NO.: PERMIT
C7,
NUMBER 680380
P /- / 00,
� r 1 1 [3 YES
KISTIN&�'S'TREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W - ......... 17r.
4?, d"'o
[:I YES
Plan Check No ............
BUILDING
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 to 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-
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
rolattag to Workmen's Compensation Insurance.
NOTE: Permit Limit one Year (Except DE31OLITIONS which
ahall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
Ila
NOTE: Applicant S Check Fee
-iiTa —reradt covers work to be done an Private property ONLY.
Any construction on the public domain (cwtiN. sidewalks, driveways,
marquoes, ete.) will require separate Permission.
Tius PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DE RTMENT
CITY OF
EDMONDS
PH 6-1107
Valuation
0 YES adfo--�
Fee
V0
NO.
Li— / .,I� 0 loW if ;
APPLICATION APPROVAL
This application is not a perntit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
imowledged in space provided.
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