680495.pdfBUILDINGDEPARTMENT Applicant Fill
PERMIT APPLICATION- Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
6 #_ T e.
ADDRESS
CITY
OV TELYfHONE NUMBER
rR 6--'� 06 �
L,U AJ Z
NAME 'F0
TO 1Z
4"'Lt
ADDRESS,
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S
CITY
TELEPHONE Nt
STATE LICENSE NUMBER
CITY LICENSE I
Legal Description of Property (Show Below or Attach Four C
7_1
I' JV 0 0 1>
Z
Q A- ar t-
EJNEW
RESIDENTIAL
NON-RESIDENTIAL
GAS
LINE
SIGN
ADD
ALTER
E] REPAIR
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
INSP.
RETAINING
WALL
FENCE
( .......... x .......... Ft.)
swim
POOL
NUMBER or
DWELLING
UNITS
PROPOSED USE
PLOT PLAN (Indicate Building setbacks, abutting streets)
23
—oa
+
A
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-
lzed 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 DE51OUTIONS which
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com.
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fce
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivinvays,
marquees, etc.) will require separate permission.
PERMIT
i ON KROLL MAP NO.:
NUMBER
680495
DRESS
I nEAR YAR]r SETRACY.
EXISTING STREET R/W ....... .... FT -
COMP. PLAN ST. R/W ............ FT.
[] YES
or
ALV_
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE:
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR F71LL
ITOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 8-1107
/ 4; 0
VACANT SITE
YES 0
VARIA
DEFICIENCY THIS PROPERTY
BY
0�
[] YES [3 NO
Valuation i Fee
(000J�5 1 lAi- I
Z
TA
No.
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-
Imewledged in space p;pyided. ft. /) I
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