690379.pdfI
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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINEBS)
A1141d k;elt M
ADDR 8
1_41
10 1 ___ . .. �.,
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AJ
i Am
03
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or
A
)N KROLL MAP NO.: PERMIT
I NUMBER 69037c)
X88
/ 9 3�,2 0 V 5 1\./
I
0 YES
Z
0
UMBER
4Z
13TREF&/�,_V� 11
EXISTING STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT- ............ FT.
�,A_/ I [] YES [3 NO
I-
0
Z
N
NEW
DALTER
1:1 REPAIR
RESIDENTIAL
I
NON-RESIDE��
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
El INSP.
[]
El
GAO
LINE
SIGN
RETAINING
WALL
FENCE
( ........ . x ..........
SWIM
POOL
YES
aPLAN VBYO
CRECKE
AZ_J
REMARKS
I
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
I
Valuation
Recalpt No.
(-_17�J
rise, Check No ................. ...
BUILDING
PLUMUING
HEAT & GAS LINE
PENCE
SIGN
I
tRETAINING
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
J 0-1 1 17�. 60
I hereby acknowledge that I have read this application; that the in-
L AMOUNT
TOTAL AMOUNT DUE
formation given In 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-
I&ting construction; and In doing the work authorized thereby, no person
ATTE NTION
A NTH
APPLICATION APPROVAL
will be employed in violation of the Labor Code of the State of Waahington
THIS PER311T
T 8 PER31
This application Is not a permit until
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shan be completed in ninety days; MOVED -IN BUILDINGS ahall be com.
plated in six months.)
BIONA'Au %0 NER 010 AGENT) DATE SIGNED
IL� d1i o16
ITOTA
13 Ju I
AUTHORIZES
ONLY THE
WORK NOTED
N 3
INSPECTION
DEPARTMENT
CITY �J
L CITY OF
EDMONDS
signed by the Building Official or his Dep-
Uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DIRECTOR'S�! MGNAT
DAJ�;�
NOTE: APPlicant Subject to Plan Check Fee
PR 6.1107
FILE
ds Permit covers work to be done an private property ONLY.
Any construction an the public domain (curb@, sidewalks, drlvewlLYD,
marquee$, ate.) will r0401" 501"srstc Parnassian'