680530.pdf.BUILDING DEPARTMENT Applicant M
baside Heavy Lines
PERMIT APPLICATION
NAME (0 N(A7 OF BUSINESS)
rL 4 )v /n
MAILING ADDRESS
a .34) low
TELEPHONE -NUMBER
r
-7 _4
NAME
CITY TELEPHONE NUMBEJK
NAMM
C4
Z
a
or
rn
i
RESIDENTIAL
GAS
ElNEW
9
LINE
NON-RESIDENTIAL
DRETAINING
SIGN
DEMOLISH
WALL
DALTER
EXCAVATE
PENCE
D
OR FILL
( x Ft.)
E] REPAIR
1:1
PRE-MOVZ
INSP.
........ . ...... ...
SWIM
POOL
DWELLING
UNITS
t
N
I
I hereby acknowledge that I have read this Application; that the In-
formation given In correct; said 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
relaUng to Workmens Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
C
P NO.: PERMIT
NUMBER
4
Do � e:2
SIDE YARD BETBAC REEr SETBACK REAR YARD SETRAPK
Z LOT ARE& VACANT SITE
13 YES NP6NO
om�m�f a I I T BUILDING AREA VARIANCE AUMBER ow
EN38TING STREET R/W ...-_..FT.
COMP. PLAN ST.
TYPE OF
(3 YES [3 NO
PS A/d h2 . .9
Plan Check No...
DEFICIENCY THIS PROPERTY
:2-
Valuation
E3 YES C3 NO
Fee
3
0
.3"00,
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I_
EXCAVATION OR FILL
TOTAL AMOUNT DUE
!!2 —
I
I Z,!L — 7�/O A N
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done an private property ONLY.
Amy construction on the public domain (curbs, sidewalks, driveways,
marquees, ate.) will require separate permission.
ATTENTICON
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTh[ENT
CITY OF
EDMONDS
PR 6-1107
APPLICATION APPROVAL �
This application Is not a permit until
oigned.by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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