700131.pdf.BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Ilcavy Lines -j-0-13
NAME (Olt NAME Or BUSINESS)
12 &A 4 SID
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MAILING ADDICNUS
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CITY
TELEPHONE NUMBER
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NAME
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A ADDRESS
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CITY
TELEPHONE NUMBER
RE
NAME
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ADDRESS
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CITY
TELEI-1-10NE NUMBER
STATE LICFrq8N LNUMBER CITY LICENSE NUMBEIt
r;t:2Z__ 01� 3995� it]
-
Legal Description of Property (8how Below or Attach Four Copies)
7
4o-r 7_-4;,0R!4 WeL""_ Y
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F
GAS
EaRESIDENTIAL LINE
NEW
I
El NON-RESIDENTIAL SIGN
ADD RETAINING 11
1:1 El WALL
DEMOLISH
DALTER EXCAVATE FENCE -
1:1 OR FILL ( A Ft.)
......... ..........
REPAIR PRE -MOVE swim
1:1 INSP. POOL
-RUSMER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE D,0NE
PROPOSED USE-
3
PLOT PLAN (Indicate Building setbacks, abutting streets)
21
t
N
I hereby acknowledge that I have read this appllcatl on: 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 DE51OLITIONS which
shall be completed l2nety ays; OV 'D-IN BUILDINGS shall be com.
pleted In nix months.
815NATURE (OWN OR AGENT)
DATE SIGNED
0). 7ry,46=_
� 3 _,e9d
"Wk.
xTr - Ahhl(oAt Subiect to Plan Check Fee
�'.';`c;n,ir`u'ct1on on the public denude (curbs, sidewalks, driveways,
marqums, etc.) will requiro separate permission.
- , 7 00131
0 ZONE
LOT AREA
,0
T W
YES
:GHT
DUILDI95 AREA
VARIA NCE REBER
N
)T PLA A VED
t
I&ING STREET R/W ............ FT.
DEFICIENCY THIS PROPERTY
!OMP. PLAN ST. R/W ............ FT.
............ FT.
MARKS
Z
I CHECIFED—BY
tITER SIZE SERVICE 81ZE CLEARANCE
CHECKED BY
PUARKS
tPE CONNECTION
VERIFIED BY
MC. TEST
PERMIT NUMBER
EMARKS
ERE ZONE TYPE OF, CONSTRUCTION STREET IMPROVED
YES
0 215ro-
?ECIAT 'NSPECTOR REQUIRED
GROUP
JOCCUFANCY
YES
LAN CRECKIPD BY
EMAW
Inn Check No ................ . ...
MAT & GAS LINE
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
TIUS PEMIXT
AUTHOIUZES
ONLY TIM
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
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.
I N - I ___ _ I