700103.pdf- - - - - - - - - --
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POSTED ON KROLL MAP NO.: PERMIT
NUM13ER
-7
00103
BUILDING
DEPARTMENT Applimnt FIR
PERMIT
APPLICATION Inside Heavy Lines
JOB ADDRE88
NAME (Olt NAME OF BUSINESS)
9 Q 45 a — /S '-/ 6,(-,
Melvin
E. DE VERNA
SIDE YARD SETBACK STREET SETBACK
REAR YARD eW
MAILING ADDRESS 8232 184th St. S.W.
d
Edmonds, Washington
USE ZONE LOT AREA
VACANT SITE
CITY
TELEPHONE NUMBER
Ll YES ter
Edmonds, Washingtol PR6-9009
I NAME
Melvin E. DE VERNA
A ADDRESS
6232 184th St. S.W.,Edmonds, Wn.
CITY TELEPHONE NUMBER
Edmonds, Washingto� PR6-9009
NAME
Same as 9bove
ADDRESS
TELEPHONE NUMBER
CITY
or
NEW
1XI RESIDENTIAL
GAS
LINE
1
1:1
NON-RESIDENTIAL I
f I
SIGN
RX ADD
DEMOLISH
RETAINING
WALL
EXCAVATE
FENCE
ALTER
OR FILL
( x Ft.)
REPAIR
PRE -MOVE
.......... ..........
swim
INSP.
POOL
DWELLING
One UNITS
'URE OF WORK TO BE DONE
Add on one room 11, bv 151
PROPOSED USE
Famiiy room
PLOT PLAN (Indicate Building setbacks, abutting streets)
Street 184th S.W.
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 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 DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
IIGNATURL (OWNER Olt AGENT) J DATE SIGNED
. omm�,=, 1 -.1 �Ilt
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curba, sidewalks, driveways,
marquoes, etc.) will require sepamte pern-Joslon.
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
DEFICIENCY THIS PROPERTY
............ IV.
Z
14
TYPE
It=
0 YES 7�0 NO
13 YES [:] NO
REMARKS
14IF671 PIA). A6006
RemrS OF 1%70,6C * IS
517"6 A6P6C7r1dA1 1qX CdA#Z1&jC6r I
I Valuation I Fee I Receipt 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 I I t7 ��
ATTE4 NTION
APPLICATION APPROVAL
THIS PERMIT
MIS application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
uty; and fees are paid, and receipt is ac-
WORK NOTED
knowledged in space provided.
INSPECTION
DIRECTOR-_ `21=—
DEPARTMENT
X
CITY OF
MNIONDS
0
PH 6-1107
I
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