690146.pdf4
BUILDING DEPARTMENT
PERMIT APPLICATION
NAmln (OR NAME OF BUSINESS)
Ailr,l 7-
12 - / 1�
121w.w1vos ,
E
, T�) //_/V
tI-)II11,2S
I
MNEW
MADD
DALTER
0 REPAIR
I
y
W
Applicant Fill
Inside Heavy Lines
Z? -, C4 f
RESIDENTIAL
AS'
NON-RESIDENTLUL,
R
!rN
SIGI:
DEMOLISH
RETAINING
WALL
EXCAVATE
OR FILL
FENCE
.......... Ft.)
PRE -MOVE
INSP.
F-1
SWIM
POOL
DWELLING
UNITS
3
I% 7 R,4 C t- A - —
I hereby acknowledge that I have read this application; that the in-
formation given is 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 allthorized 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 to ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate permission.
ON KROLL MAP NO.: PERMIT
NUMBER
,FEES
LRD SETBACK
STREET SETBACK
NE
LOT AREA
MA��& /. 2
EXISTING STREET R/W .... FT.
COMP. PLAN ST. R/W ..... MFr-
S
13 YES
plan check No ..................
YARD SETBACK
NT SITE
A
LNCE NU99ER
DEFICIENCY THIS PROPERTY
Valuation
5-yf-S 0 No
No.
BUILDING
0) o07 -7
I-
#� �I
PLU3IBrNG
F F
&0
HEAT & GAS LINE.
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
'0
2 :5�
?
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
Tills application is not a pernilt until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION
--D-LRECTOIVB- SIGN
DEPARTME14T
CITY OF
EDMONDS
DATE
PR 6-1107
I
0
I