680535.pdf)1�
POSTED ON IMO MAP NO.: PERMIT
�7 NUMBER
BUILDING DEPARTMENT Appileallt Fill
Inside Heavy Lines
PERMIT APPLICATION 15 JOB :288 r
�_ f L
NAMM (OR NAME OF BUSINESS) SIDE YARD SETBA. CK GrEET 8 CK
Gr y I L,
e
.4
e_ -3 Fe
I
No
[3M—NOZ >Uk—ER N
—v I �1
EXISTING -STREET R/W ... ....... XT- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ Fr. .......... PT.
M.
10 YES 0 NO
GAS (:3 YES PNO
NEW RESIDENTIAL LINE PLAN CHECKED BY
LEII -TON -RESIDENTIAL SIGN 1�j
ADD RETAINING REMARKS
ElDEMOLISH 13 WALL 0
ElALTER EOCCAVATE PENCE
El OR FILL ( ........ . x ......... Ft.)
REPAIR PRE -MOVE SWIM
1:1 INSP. POOL
ES NUMBER OF
DWELLING
UNITS
4ATURE OF WORK TO BE DONE
valuation 0.
reei?,arlall
Plan Check No ..................
PROPOSED USE
i,-'T C, 0% -51- Wee-
BUILDING
_J9f
PLOT PLAN (indicate Building netb&CRA, abUt
PLUMBING
0
47 -rA cwte-v
HEAT & GAS LINE
PENCE
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; *33at the In-
formation given Is correct; and that I am the owner, or the duly author-
tzed agent of the owner. I agree to comply with city and state laws rvgu'
ATTENTION
lating construction; and III doing the work authorized thereby. no person
will be employed In violation of the Labor Code of the State of Waablrigton
THIS PERMIT
relating to Workman's Compensation InmUmOcc.
AUTHORIZES
ONLY THE
NOTE* Pe it 1.1mit One Year (Except DEMOLITIONS which
0
WORK NOTED
co d in net VED-IN BUILDINGS shall be com-
mhal be y
I
in nthm
plated a, x
OP
BIG AT (0 0 DAWN N"Li
INSPECTION
DEPARTMENT
/C
CITY OF
EDMONDS
NOTE: Appli"ni Subject to Plan Check Fee
PR 0-1107
This Permit covers work to be done an private Property ONLY -
Any conatraction on the public domain (curbs, sidewalks, driveways,
marquees, eta.) will require separate PerrulsfilOn-
md
(5,
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or Ms Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
a
I