700295.pdfPOSTED ON KROLL MAP NO-: PERMI
BUILDING DEPARTMENT AppUcant F NUMB= 700295
Inside Heavy Lin JOB ADDRESS
PERMIT APPLICATION c A�4
NAME (OR NAME OF BUSINES
's, 0AI SIDE YARD I SETBACK STREET SETj
MAILING ADDRESS 40 / 4f
8 ONE LOT AMLEA
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CITY ELEPHONE NUMBER
Al BUILDING AJ
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NAME -3 9V��A X _2 A_.i�
PLOT PLENP ROVED
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ADDRESS
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9<7 7ES7NG STREET R ��.I?T.
CITY TELEPHONE NUMBER /W
I comP. PLAN ST. R/W .... FT.
LDL( 7L/ REMARKS
NAME
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Cd ADDRESS
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CITY
METER rIZE ERVIC CLE,
STATE LICENSE NUMBER CITY LICENSE NUMBER _ 44 1 /1 " I
it
Igg F3, REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
RO , L _r /I AQ, 00 1�r� E CONNECTION
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WIE F,
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FIRE ZONE TYPE OF CONSTRUM
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tEMARKS
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RESIDENTIAL
ED
2INE
aNEW
1
NON-RESIDENTIAL
0
SIGN
ADD
DEMOLISH
RETAINING
WALL
EXCAVATE
PENCE
ALTER
OR FILL
( x Ft.)
REPAIR
1:1
PRE -MOVE
El
.......... ..........
SWIM,
INSP.
POOL
TUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
4ATURE OF WORK TO BE DONE
zz) Z�
PROPOSED USE
7-4 e-
PLOT PLAN (Indicate Bull
P
c, 1, —
[] YES
Plan Check No .....................
BUILDING
PLUMBING
5o
tRETAINING
HEAT & GAS LINE
FENCE
SIGN
WALL
IN
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL ABIOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given In correct; and that I arn Ito owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
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
THIS PER511T
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
lIGNATURE (OWNER an AGENT) DATE SIGNED
INSPECTION
j
DEPARTMENT
I_M
CITY OF
EDMONDS
NOTE: Applicant Siibject to Plan Check Fee
PH 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drlvewvjo,
marquees, etc.) will require separate permission.
�z 0 / 0
VACANT SITE 0� I
0 YES g'NO Z
VARIANCE NUMBER
THIS PROPERTY
6
[3 YES 2wo�
Valuation Fee
), _036 o
- 1 701
1�1�11C
No.
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.
7-0
FILE
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