690148.pdfos,rED ON KROLL MAP NO.: PERMIT
=NU M B LER (390148
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BUILDING DEPARTMENT Applicant
]Inside Heavy Linels 6 v-(, �.-S 7 10��
PERMIT APPLICATION 7
(OR NABIN VV DO I E!S)
MAILING A.DDRESS
CIT NUMBER
-7 ? til— �'� Jr
ADDRESS
CITY
F.11
1-7 -2 f
NAMM
IALWA-P-W
YES
ma..� ./� y THIS PROPERTY
EXISTING STREET R/W ... ........ FT- DEFICIENC
COUP. PLAN ST. R/W ........ .. XT- ....... .... FT.
Z UETER SIZE I SERVICE SIZE CLEARANCE CHECKED By
STATE CITY LICENSE NUMBER
I REMARKS
or
o7 d/ —/L V'/-. .
YES E3 NO
R RESIDENTIAL
0
GAS
LINE
a —Y8 R!—No I ..&
PL N CHECK= By
DNEW
NON-RESIDENTIAL
Li
SIGN
INlu
AVV
DEMOLISH
RETAMING
WALL
REMiLtuto
6-r"c-rug,4z.. At-rw?AVOI-J-5
ALTER
EXCAVATE
OR FILL
PENCE
( .......... X-,**'*"* Ft.)
4A10
F� REPAIR
PRE -MOVE
INSP.
swim
POOL
qUMBER UP STO—RIE13
NUMBER OF
DWELLING
UNITS
k. (C � r, 'C -, C' 'q. - '0 "-, , - e-I., n i
QYUSED USE e, �t it, e
, �/ A " � ;;.
u S e'e1w;0 e.
Plan Check No ....................
BUILDING
PLUMBING
BEAT & GAS LINE
PENCE
t
SIGN
N
REMAINING WALL
SWI NG POOL
OLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formaUon given In correCL; and that I 8= the owner, or the duty author-
ized agent of the Owner, I agree to comply with city and state laws rQgu-
ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor "a of the State Of Washington
THIS PERMIT
relating to Work=en'x Compensatlon. Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Umit One Year (Except DE',%IOLITXONS which
WORK NOTED
shall be completed in ninety days; MOV7A�_IN BUILDINGS shall be COM-
pleted in six months.)
INSPECTION
(OWNER I I I I DA IGNE
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
Pn 6-1107
This Permig coven work to be done nOprivate property ONLY.
Any construction on the V b1le domain (curbs, sidewalks. drivaWaYs.
all
manueea, etc.) Will require sepaxste permission.
Fee
�a &0 , Cr6
I
0
Z
W
No.
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 provided -
DATE
IL 1 e4s,
FILE 0, �
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