690444.pdfIV
KROLL MAP NO.:
PERMIT
BUILDING
DEPARTMENT
Applicant F1
NUMBER
�%444
Inside Heavy Lines
JOB
ADDRESS 64J
49
__�PERMIT...APPLI,CATION.
PqA_0 V-^
W175
C
CITY
I . .0 a,, I I
or
Lor /0
y C ZZ:0
13 YES 13 NO
EXISTING I STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT. -
FIRE
RESIDENTIAL
GAS
LINE
13 YES
NEW
PLAN
NON-RESIDENTIJAL
1 8
0
SIGN
0 ADD
RETAINING
WALL
REMAJ
ALTER
0
DEMOLISH
EXCAVATE
OR ]PILL
]PENCE
( x Ft.)
.......... ..........
REPAIR
El
PRE -MOVE
INSP.
SWIM
POOL
-NUMBER OF
DWELLING
UNITS
0
I -Ian Check No .....................
I a n C h c k
D I N G
BUILDING
B U L
MB I G
PLUMBING
P L I N
L
HEAT & GAS LINE
- A T G A S
N E
C
VENCE
N
SIGN
SIG
tRETAINING
WALL
N
SWIMMING POOL
EMOLITION
D EM
ECTION
PRE -MOVE INSPECTION
PR MOVE INSP
XCAVATION OR FILL
,X ATION 0
E F C V
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 -
[zed agent of the owner. I agree to comply with city and state lawn regu- ATTENTION
lating construction; and In doing the work authorized thereby, no person
T"
11
will be employed in violation of the Labor Code of the State of Washington TIUS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEIMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVEDAN BUILDINGS shall be com-
pleted In I t'a DATE SI NED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PH 6-1107
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.
ME
W
STREET IMPROV]
(J YES (2 NO
Z
F:
Fee Receipt No.
L
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his Dep-
uty; and f ees are paid, and receipt is ac-
knowledged in space provided.
DIRECT
DATE