710216.pdf1 ,
f
A
BUILDING DEPARTMENT
Applicant FiH
PERINIT APPLICATI®N
Inside Heavy Linea aos
o
NAME (O n
/y%lc ,/ -ftt„ � `% /^/ sin
i�V y I O -� l
MAILING ADDRESS /1
1/ Uf
O
CITY
TELEPHONE NUMBER
FIE
NAME
PL
F
pUi7
ADDRESS
rT
— El.
Y.
!C
CITY
TELEPHUNE NUMBER
RE
D.
07
ADDRE 0
3
/
ITY
TELEPHONE NUMBER
�6a�3-853yz
M
STATE LICENSE NUMBER
CITY LICEN8E NUMBER
I R,
Legal Description of Property (show Below or Attach Four Copies)
F
O
F
_
P
t7
47
R
O
O
k7
.7
F
8
GAS C
RESIDENTIAL LINE p
NEW
NON-RESIDENTIAL ❑ SIGN
A
ADD ❑ ❑ WALL
DEMOLISH
E ❑ PENCE
❑ ALTER ❑ EXCAVATE
ORFILL xFt.)
..........
REPAIR ❑ PRE -MOVE SWIM
INSP. El POOL
NUMBER OF STORIES
NUMBER OF
/
DWELLING
I UNITe
4i�,f 1 OtitQ G/�/wlLA(•
_
NATURE OF WORK TO YE DONE
I
q
P POSED U8
7
a
PLOT PLAN (Indicate Building setbacks, abutting streets)
h
O
1
1 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; BIOVED-IN BUILDINGS shall be com-
pleted In six months.)
SI6 TUBE (OWN OR AGENT) DATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the pablic domain (curbs, sidewalks, driveways,
marpuees, etc.) will require separnle permission.
PERMIT
NUMBER
A /
I;, // -- `/03
BARD
SETBACK I
BT� SETBACK
Y
III
� I �'^•h' AC/�+'
/
EnT Attx.A
. I VAC
110216
1
�SETBACK
4TZ
❑ NO
[UMBER
i
i
s
1 �
t
ISTIN6 STREET R/W [[� ...FT. DEFICIENCY THIS PROPERTY
)OMP. PLAN ST. R/W .:.1G...FT. .......FT. '
MARKS
Aveway slopes not to exceed those indicated
1 Standard Drawing #103.
IPE
OF
YES ❑ NO
LAN CHECKED BY
EMARKS
BY
❑ YES O NO
Valuation Fee Receipt No.
InnCheck No .....................
IUILDING
'LUMBING
TEAT A GAS LINE
-ENCE
3ION
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL `
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DIRECTOR'S S GNATU tE'-
'
DEPARTMENTL/,
CITY OF
DATE
EDMONDS
_ Q
PR 6-1107
FILE
1,
tt
t