690024.pdfC 11
UILDING DEPARTMENT
PERMIT APPLICATION
4AMS (
N7 OF BUAINZHS)
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KROLL MAP NO.: PERMIT
Applicant FM I NUMBER, 690024
11IM418 H0&VY JAU05 JOB ADDRESS
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13 YES
EXISTING STREET DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... Pr. ........ ... FT.
or
r 'Yl I I I L -.1 __ - - __ - Tit YES C3 NO
4dJ±j02 01 spi= IINSPLCTOR RZQ�Inzla OCCUPANCY GROUP
V . AS 0 YES 0
0 RESIDEN+ D&NZ PLAN CHECKED BY
El NEW VIAL I [:]
vIAL 81
10
ON
NON-RESIDEN I
1:10 RETAINING REMARKS
DEMOIARTT WALL
EXCAVATE PENCE
OR FILL F1 ( ........ .
REPAIR PRE -MOVE swim
INSP. POOL
IUMBER Or STORIES I NUMBER, OF
DWELLING 1�j Ly
UNITS
I
valuation I Fee I Receipt No.
Plan Cho* No .....
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
I
! t
SIGN
RETAINING WALL
SWIM30NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR PILL
I — TOTAL AMOUNT DUE
I hereby acknowledge Mat I have read this application; Mat the III -
formation given is correct; and that I am the owner, or the duly author -
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Mrs dg I v
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ed a a to cc
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Ized agent of the owner. I agree to comply with city and state laws regu- ATTENTION APPLICATION APPROVAL
latIng construction, and In doing the work authorized thereby, no pmon
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a Hca n ' t to
wDe 0 duly W- TOTAL
ael"Dw`6 6 the Iba a read this pp ortl� is I A"
Me Me
with d
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Me 0 mp'y city en te awe
th Wd thareb 0 person
or n
th �abc od� I the State of ashington' Tfu
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7 nas Ineurance AU
ou work
�will be employed In violation Of the Labor Code of the State of WafiblUgton THIS PERMIT This application is not a permit until
r in ed "
elating to WorkmeWS Compensation Insurance. AUTHORIZES signed by the Building Official. or his Dep-
ONLY THE
EMOUr 0 Wol
it Exec I D NS which WORK NOTED uty; and fees are paid, and receipt is Re
NOTE: Permit Limit One �Yeqr (Except DEMOLITIONS which
cc a n ty
a,te,l In ninety days; MOVE ) IN BUILDINGS dnall DO OOM-
led in W "a . mo�M BUILDINGS hai com
Te or days; MOVFM-IN BUILDINGS shall be com knowledged in owe provided.
PI I on�.)
il 11 on
mths.)
PI
US W1
R 0 AGENT) DATE IGNE INSPECTION DIRECTOW. H1U1VVA:uzw
DMI
DEPARTMENT
CITY OF
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NOTE: APPlicant Subject to Plan (1hec EDMONDS
PE 6-IL107
�Thlaftrmlt &ven work to be done eaprivate proputy ONLY.
Any constmeglOIL an the public domain (curb$, sIdOWAUEB, driveways, sum
Marquess, so.) will require sep"Ate permission.
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Landscaping
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