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BUILDING DEPARTMENT[�ta� Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME OR NAME OF BUSINESS)
ARreRQ. Rog Ids
MAILING ADDRESS
9e2i9-6Zy�MP,r✓ �E� pr
CITY ---- - TELEPHONE
E�DHO#j pS I
NAME
,
AR�tio�d C. ®a�+ 4/
ADDRESS
-Aplitoo0b I P/9,• r?o6
TA E LICENSE NUMBER CITY LICENSE NUM]
P NO.: I PERMIT
NUMBER / Cl newsy, n
�ICt- UluMQ;0 U1ew I�r�ue
ARD BET13ACIC REEI BETBACK REAR YARD SETBACK
lb�yhinl 1-JLVnirl I 75� Ml 52
7 E I LOT AREA I VACANT BITE 1
YES NO
1 BUILDING AREA I VARIANCE NUMBER e,
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
N
GAS 21 RESIDENTIAL ED LINE ❑ A(�
NEW PLAN CHECKED B ;
ElNON-RESIDENTIAL ElSIGN
® ADD ❑ ❑ WALL NINE REMARAW
DEMOLISH
ElALTER ❑ EXCAVATE ❑ FENCE
OR (........ ..x_........ Ft' )
REPAIR ❑ IRE -MOVE SWINSPIET L
NUMBER OF BTORIE9 NUMBER OF
/ DWELLING
UNITE
NATURE'OF
1,WORK TTO/B^7E-'DONE y, 1A�tt{�� ��t
N C VV `\ V (yt' 1.� 1 V I RI E �� Plan Check xo...._ .......
)J R bb Eb Tg ' n ( O f� BUILDING
PROPOSED USE
,1 n1 \ A 1 ' `�,1
1 `. �• 1 uS�+E. V - � L `A 10 V li PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets) [••�� HEAT & GAB LINE
FENCE
SIGN
�v A
\ (f t RETAINING WALL
I
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
1 EXCAVATION OR FILL
I hereby acknowledge that I have road 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 slate 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 Workmen's Compensation Insurance,
NOTE: Permit Limit One Year (Except DE411OLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIGNATURE OWNER OR AGENT t DATE 8IGNED
aim u1r io G
NOTE: Applicant Subject to Plan Check Pee
This Permit coven work to be done on private property ONLY.
\` Any construction on the public domain (curbs, sidewalks, driveways,
\ marquees, ate.) win require separate perndssloa.
TOTAL AMOUNT DUE.
ATTENTION APPLICATION APPROVAL
THIS PERMIT ..This application is not a permit until
AUTHORIZES sighed by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided,
INSPECTION IRECTOR'B SIONATUR,
DEPARTMENT
CITY OF _
EDMONDS DATE
PR 6-IIe7 /
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