680545.pdf03
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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines J _0B A
NAME (OR NAME OF BUSINESS)
F&-7 —) 6-1Z �� C_ SIDE
—MUL—ING ADDRESS
TTAM
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(TITY TELEFHONE NuMallia
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NAME
ADDRESS
CITY I �Tr"VHVNE NUMBEE—
<—,4,J f:�/Q e4A 11C D I
NAME
I qedt,-s 6�� Cotsc-1467
,�eet-r-Ff.- F, F_� if -�,Ct
STATE LICENSE NUMBINK CITY LICENSE RUI
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P I -Fto -/
V
I lls�
iN KROLL MAP NO.:
PERMIT
I NUM13ER
6W545
EBB
� �716—
LD SETBACK
STREET
SETBA
&RD SETI
1 792
;� 'tn
X11--1 1
1-5-' 222,
-5-
"*
13 YES
KISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ liv.
OW44DI
NEW
ADD
ALTER
RESIDENTIAL
1 E] NON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FILL
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( ........ . x . ........ Vt.)
0 YES
PLAN CHECKE
REMARKS
Fence
I
REPAIR
PRE -MOVE
INSP.
swim
CaPOOL
(UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
[:I NO
13 YES El NO
t to be obtained.
Plan Chech No ............ . .......
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
01
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 thin application; that the In-
formation given Is 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-
ATTENTION
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
THIS PERNUT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Yeur (Except DE31OLITIONS which
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
plated In six months.)
S1 NAT RE OWN 0 GENT)
DATE SIGNED
INSPECTION
7R
DEPARTMENT
'ITY OF
EDMONDS
NOTE: Applicant Subject to Plan Cbeck Fce
PR 0-1107
This Permit covers work to be done on prIv"e property ONLY.
A" construction on the public domain (curbso sidawalkat drlvewayso
marquees, age.) will require separate permission.
Fee
1�
s-0 0 0 0
APPLICATION APPROVAL
0
No.
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
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