690370.pdfN KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Flu NUIUSER 690370
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PERMIT APPLICATION I
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CITY
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ADDRESS
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CITY TELEPHONE
NAME es�) 10 td,
ADDRESS
CITY TELEPHONE
A
STATE LICENSE NUMBER CITY LICENI
or
EP-<SIDENTIAL
E]
GAS
NEW
LINE
I E] NON-RESIDENTIAL
El
SIGN
ADD
RETAINING
DEMOLISH
WALL
0]--A—LTER
EXCAVATE
OR FILL
PENCE
( x Ft.)
E] REPAIR
PRE -MOVE
INSP.
........ . ........
swim
POOL
NUMBER OF
DWELLING
UNITS
t
91
X
EXISTING STREET R1W ............ FT.
COMP. PLAN ST. R/W .......... XT.
E] YES [] NO
PLAN CHECKED AY
Plan Check No ...........
BUILDING
PLUMBING
BEAT & GAS LINE
PENCE
SIGN
tRETAINING
WALL
I
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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 lawn 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 DEMOLITIONS which
shall be completed In nicety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
1IGNATURE (0%"ER R DATE J31ONEP
f , V?()//
A,—!4 X644-o a.) I �/ &, �y
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,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
REAR YARD SET71HIACIK
_ 0 1
VACANT SITE X.
[3 YES 10
N
VARIANCE NUMjiZR
CY THIS PROPERTY
............ liv.
13 YES 13 NO
Valuation Fee necelpt No.
APPLICATION APPROVAL
This application Is not a permit until
signed by Uie Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DLRECTOR'S SIONAT#
0 — 0
P11
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