690123.pdfI
C.
BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
-MAMA (OR NAKM OF BUSINESS)
190(pa Sc)-TTM 6) 0
(Wote UZ-311-0-
h[AILING ADDRzss
Z30 0
CITY TiCEZ-FRO—NENUMBLit
rq.awKvc�WtM4
F061322
NAME
ADDRESS
CITY
TELEPHONE
14UMBM
NW
my" 11�qv
ADDREW
CITY
r L
T
TELEPHONE
NUMBER
Fk(o-23VI
NEW
RESIDENTLLL
GAS
LINE
NON-RESIDENTIAL
SIGN
RETAINING
WALL
DEMOLISH
EXCAVATE
PENCE
ALTER
n
OR FILL
PRE -MOVE
SWIM
REPAIR
n
INSP.
POOL
NUMBER OF STORIES
NUMBER OF
_z,
DWELLING
UNITS
I-
i
rM
N*
7
7i
I hereby acknowledge that I have read this application; that the In-
formation given to 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-
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 Workman's Compensation Insurance.
NOTE: Permit I %0ne Your (Except DEMOLITIONS which
y
shall be cow ad In y days; MOVED -IN BUILDINGS shall be com-
plated In uths
C&OTE: Applicant Subject to Plan Check Fee
This Permit covm work to be done on PrivAU Property ONLY.
Any construction on the Public domain (curbs, sidewalks, driveways,
war9juees, etc.) will require separate permission.
I
TED ON KROLL MAP NO.: PERIM
1,el I' NUMBER
ADDRESS
/ 3-� 0 o —
10 YARD SETBACK I STREET SETBACK
0, M;V)
690123
BITE
ONO
;ill NUMBER
IET R/W s��Iaxr. DEFICIENCY THIS PROPERTY
ST. R/w.4.i�Z.rr. ... 0-..rr.
indicated on Standard Drawing
[] YES
Plan Check No ............
30
0 Tze
No.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
A7
TOTAL AMOUNT DUE
ATTEISMON
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
WORK NOT=
uty; and fees are paid, and receipt is ac-
knowledged in space providecL
INSPECTION
DEPARTMENT
DAM;CTOR'S UMNA
CITY OF
EDMONDS
PR 6-1107
rim
e&l .
I
J
ki
Fire Dept.