690017.pdfI
BUILDING DEPARTMENT Applicant Fill
PE�RMIT APPLICATION Inside Heavy Lines
;roN M (OR NAME OF SINESI)
6
0 Fl�v(L OCS Z-/Vc.
M U ILt
AILING ADDRESS
41
CI
,4
,0;
21ONE NUMBER
or
NEW
Li RESIDENTU
I
GAS
LINE
El
NON -RESIDE TIAL
SIGN
0 �"�
RETAINING
0
EJ
WALL
DEMOLISH
ALTER
0
EXCAVATE
El
PENCE
on FILL
( ........ x .......... Ft.)
REPAIR
PRE -MOVE
swim
INSP.
POOL
NUMBER or
DWELLING
UNITS
t
N
I
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-
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
relating to Workmen's 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.)
TURE (0 CER OR #GENT) DATE SIGNED
' / - / —
NOTE: Applicant Subject to Plan Check Fee
This permit covers Work to be done 091 private Property 01`416y-
Any construction on the public domain (curbs, sidewalks, drivowILY0,
m"que0o, etc.) win require separate permission.
PERMIT
NUMBER 690017
�9' Co. 1hWt',t'U'
I 1 0
USE ZONE �ur AREA VACANT SITE
I I E3 YES 13 NO
T4r.1C3HT I BUILDING AREA I VARIANCE NUUJJNK
EXISTING STREET R/W ....... .... FT.
COMP. PLAN ST. R/W ............ 11'r.
0 YES [3 NO
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINYXG WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
ITOTAL AMOUNT DUE
ATTENTION
TIUS PERMIT
AUTIKORIZES
ONLY THE
WOIU1 NOTED
INSPECTION
DEPARTAMNT
CITY OF
EDMONDS
Pit 6-1107
DEFICIENCY TBIS PROPERTY
Valuation
1*14
ANAMEMEWMS
Fee
00
S_.�
I
owl
No.
I a -S_ S-�(4-T O'N
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-
knowledged in space provide(L
1 ';7 �