700198.pdf'j" I V
KROLL MAP NO.:
BUILDING DEPARTMENT Applicant FLU
NN PERMIT APPUCASION Inside Heavy Lines JOB ADDRESS
NAME (OR NAA11a Ub- E.USINESS) 4f 74
I
18
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-tF-1V A) 0
NO ADDRESS
TELEPHONE NU F-1-2
CIV- _3 - � 7
I e j —
-3 6>2 ;5�2 3 0
or
re
GAS
NEW RESIDENTIAL LINE
NON-RESIDENTIA SIGN
DEMOLI RETAINING
ElALTER EXCAVATE FENCE
F] OR FILL F1 ( .......... x .......... Ft.)
E] REPAIR PRE -MOVE SWIM
R INSP. POOL
[ES NUMBER OF
DWELLING
UNITS
-R—OPOSED USE
Q
PLOT PKA—N(Indi
t
N
I
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 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
relating to Workman's Compensation Insurance.
NOTE: Permit Limit On Except_UE LI Nis which
M V
shall be completed In M V fN BU BPI
P1.0 ,� b �e
BU
pleted in mix month
70
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on Private property ONLY.
Any construction oil the public domain (curbs, sidewalks, drIvew"s,
marquees, etc.) will require separate permission.
,12-,
EXISTING STREET R/W ............ FT -
COMP. PLAN ST. R/W ............ FT.
OF
PERMIT %7d
NUMBER
6ki
[3 NO
DEFICIENCY THIS PROPERTY
[] YES [3 NO
[j YES [] NO
REMARKS
�� \ & C? — q () 0 11) u
Valuation I � Fee
Plan Check No ..................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
A
NTOTAL AMOUNT DUE 60.qj 0
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a perntit until
AUTHOIUZES signed by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
linowledged in space provided.
INSPECTION —DIRECT 8 SIGN
DEPARTMENT
CITY OF DATE
EDMONDS ;;?o
PR 6-1107
FILE
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