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POS
BUILDI DEPARTMENT
Applicant FLU
PERMIT APPLICATION
inside Heavy Lines
NAME (OR NAM OF BUSINESS)
BID
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CITY TELEPHONE NUMBER
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NAME
CITY
TELEPHONE NUMBER
STATE LICENSE NUMBER
TY LICENSE NUMBER
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Legal Description 01 Property (Show iselow or Attach Four Copies)
T1
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W
R:
GAS
RESIDENTIAL El LINE P
NEW
NON-RESIDENTIAL E] SIGN
ADD RETAINING
0 WALL
DEMOLISH
ALTER EXCAVATE FENCE
F� OR FILL ( ........ . x .......... Ft.)
REPAIR PRE -MOVE swim
1:1 INSP. POOL
NUMBER OF STORUES
—INUM-BER OF
DWELLING
UNITS
TO BE DONE
Un" OF WORK TO BE 11014E
PROPOSED USE
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PLOT P !,&N (Indicate BUIMIng seLmichol
I hereby acknowledge that I have read this application; that the In-
formation givea 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 authorized thereby, no person
will be employed In Violation Of the Labor Code of the State of Washington
relating to WorkmelVa Compensation Insurance.
NOTE: Permit Limit One Year (Except DE31OLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
Pleted in six months.)
SIGNATURE (0 REROR AGWT) DATE SIGNED
-,/-/ - AL�� I I -/ V -,,�
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquecs, etc.) will require separate permission.
TED ON KROLL MA P N
FERMI
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NUMUEIt
690180
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LEET RIW
[STING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
OMP. PLAN ST. R/W ........... JPT- .... .......
MARKS
LARKS
-E CONNECTE
Eu. —TEST
I
04
1 1.
CE SIZE I CLEARANCE CHECKED BY
VERIFIED BY
PERMIT NUMBER
to
3 OF C049WAUCTION STREET IMPROVED
__V_
3.1"1 10 YES 13110
?ECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES 0(wo
LAN CHECKED BY
EMARKS
/Jo :5�f/WC700AA._/�
'[an Check No .....................
lUILDING
ILUMBING
IEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING FOOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
No.
APPLICATION APPROVA-V-
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.
I
Drainage
Sewer
Parking
Landscaping
Fite Dept.
Date Passed
I
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