700060.pdfBUILDING DEPARTMENT I Applicant FIB
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
FREDERICK A. WOLGAMOTT� D. D. S.
MAUJNG ADDREFS-
503 Ninth Avenue, Edmonds, 98020
CITr WJfiLXrkLUs4l9 NUMBER
Rdmonds 776-1595
Burckhard & Hermans
J1324 Dexter North
TELEPHONE NUM
Wn. ma.3-2513
LIN, rr,
","'Raymond & Elf, Builders
01 i5 - 236th S. W.
TELEPHONE NUMBER
`6nds, 980
Ag 20
WN, �i.2-5351
FI LICENSE NUMBER CITY LICENSE NUMBER
r r
1�23*01*7497 C312-4891
.�Dascrlptlon of Property (Show Below or Attach Four Copies)
'110ftof the S 110 ftof S
1:%, - A
Of SE J of the SE I of the NW
�lof Sec 24, Twn 27 N. Range 3 EM
EXCEPT E 200 ft thereo an
EXCEPT the W 50 ft thereof,con-
veyed to City of Edmonds#1756635.
GAS
NEW RESIDENTIAL LINE
L
NON-RESID E NT F�.
M RETAINING
ennis CF�r&MOLISH WALL
ALTER EXCAVATE PENCE
OR FILL ( ........ . x . ........ Ft.)
REPAIR PRE -MOVE SWIM
INSP. POOL
DWELLING
UNITS
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I hereby acknowledge that I have read thin 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
feinting to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In nix months.)
174
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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,
marqueeso etc.) will require separate permission.
C . .
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EXISTING STREET R/W .... ...... XT.
COUP. PLAN ST. R/W ............ FT.
TYPE
[:1 YES (3 NO
Plan Check No....
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
PERMIT
NUMBER -1700060
VACANT BITE
13 YES 13 NO
6—
VARIANCE NUMBER ow
DEFICIENCY THIS PROPERTY
13 YES [3 NO
Valuation I Fee
0
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1 67 0 1
APPLICATION APPROVAL
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.
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