680503.pdfBUILDING DEPARTMENT lInside aeaVyLiBenApplicant Fill
PERMIT APPLICATION
` NAME (OR NAME OF BUSINESS)
Ralph W. Hildebrand
-MAILING ADDRM138
18927 Olympic View Drive
O CITY TELEPHONE NUMBER
Edmonds I PR&6518
t Ralph W. Hildebrand
94 ADDRESS
18927 Olympic View Drive
CITY TE PHONE i
Edmonds PR& 6518
NAME
1 Ralph W. Hildebrand
ADDRESS
SS
18927 Olympic View Drive
.� CITY TELEPHONE 1
8 Edmonds I PR&6518
STATE LICENSE NUMBER CITY LICENS)
Legal Description of Property (Snow Below or Attach Four
OO!
� W
® NEW
ADD
ALTER
REPAIR
NUMBER OF S9
One
u RESIDENTIAL OAS
_ � LINE
Q,. NON-RESIDENTIAL BION
RETAINING
El DEMOLISH � WALL
1 EXCAVATE FENCE
OR FILL El
PRE -MOVE SWIM
INSP. n POOL
1
r
g
STREET R/W ...„.-:„.FT.
PLANST, R/W .„_.„„..PT.
Plan Cheek No....„.„„._„..._
PROPOSED USE
?g{ To park cars BUILDING
a PLOT PLAN (Indicate Building istEiZGe abutting streets) PLUMBING
el
O
'+ HEAT d: OAS LINE
FENCE
t SIGN
N
I 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 Is 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
latlag 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 Workmea's Compensation Insurance. AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which ONLY THE
WOBH NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS $ball be oom•
plated In mix months,)
SIGNATURE (OVJWEVL OR AGENT) DATE S10NED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
GTE: Applicant Subject to Plat; Check Fee
PR a-IIo7
This Permit coven work to be done on private property ONLY,
Any oonstroetioo on the public domain (curbs, aldewalks, driveways,
marquees, etc,) will require separate permission,
Valuation
j..
APPLICATION APPROVAL
This application is not a permit until j
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided, i
,
D CTOR'S S NATUR 64 i
DATE
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