700297.pdf.......... ......
D ON KROLL M" NO.' PERMIT
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FB7UILDING DEPARTMENT Applicant FLU NUMBER 700297
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PERMIT APPLICATION
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NAME (OR NAME OF BUSINESS) _,8606 184th Street S. W.
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Box 451
Edmonds
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NEW
El RESIDENTIAL
1
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LINE
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NON-RESIDENTIAL I
El
SIGN
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RETAINING
0 DEMOLISH
El
WALL
DALTER
EXCAVATE
FENCE
El OR FILL
El
( a Ft.)
El
REPAIR PRE -MOVE
INSP.
......... ..........
swim
POOL
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS.
,;,&TURE OJF WORK T DONE
114C 7�7 //f IF7 ko,-2- P
e,
[] YES 0 NO
EXISTING- STREET R/W ............ 11 T. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.
REMARKS
kfW4;jbI
FIRE ZONE
[3 YES [] NO
REMARKS
IL-21[_14an Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENICE
SIGN
N
RETAINING WALL
SWIMMING POOL
I
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATIO N OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly author.
lzed agent of the owner. I agree to comply with city and state laws regu- ION
lating construction; and in doing the wor), authorized thereby, no person ATTE
will be employed In vlolation of. the Labor Code of the State of Washington TIHS PERMIT
relating to Workmen's Compensation Insurance. at the In' AUTHORIZES
'y aulhor-
jjtd
"a laws regu-
Y' no person
of Washington
ONLY THE
N I Permi, it One Year (Except DEMOLITIONS which WORK NOTED
a all a cor
'all e complc�id in nety days; MOVED -IN BUILDINGS shall be com.
P e six n�nths.)
I e il 71,er
N I)
11 ATURE OR AGENT) DAT 171 NED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject lo Plan Cklelck Fee Pit 6.1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees. etc.) will require separate permission.
Valuation
El YES [] NO
Fee
I &1e)
77t &-b I
RM
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Off icial or his D ep-
uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
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