690176.pdf4.3
BUILDING DEPJkRTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
CITY
0 MAO A_j rj
NAME
e.
ADDRESS
CITY
S
NA.ME
/i OtYIL.Oi
ADDRESS
CITY
- S.0,4 7-�I-f-
Iff-ATELICENSE NUMBEI
2.-L30 Z 3 (a C4,
51 � 450mvAJ49f
ca
0
ft
1W NEW
DADD
DALTER
17 REPAIR
e, 4A
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6 / — 2- 35 1 ef 2-
3
'em — 5— M
or
RESIDENTIAL
E3
NON-RESIDENTLAIL]
!G:
DEMOLISH
REMAINING
WALL
EXCAVATE
OR FILL
PENCE
( ....... . x .......... Ft.)
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
_C
P NOA PERMIT
I NUMBER
6901-76
]� I — 3 A�_ � elel�
VACANT SITE
C3 YES 13 NO
VARIANCE NU �ER
EXISTING -STREET DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ... ....... XT.
REMARKS i0s
(j YES [:[ NO
Z
13 YES 0 NO
NEWN..im
Fee Receipt No.
Plan Check No .................
BUILDING
PLUMBING
REA-W�T GAS XAE 01�
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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-
lattog construction; and to doing the work authorized thereby, no person
ATTENTION
will be employed in violation of the Labor Code of the State Of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
INSPECTION
D44,A_e� I A'2A I/ Zdq My OF
NOTE: Applicant Subject to Plan Check Fee EDMONDS
PR 0-1107
This Permit coven work to be done an private Property ONLY -
Any construction on the public domain (enrbs, j1dawamst driveways,
marquees, etc.) will require separate permission.
I An 41 _0201 (#'? 7:5
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt ill ac-
Imowledged In space provided.
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