710226.pdfr
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1 tom', POSTED ON KROLL MAP NO.: PERMIT 7 I U 22''6
BUILDING DEPARTMENT AppIIcant Fill NUMBER
PERMIT APPLICATION I Inside heavy Lines JOB ADDRESS Ln
1 O+cl 01 1 _ Q A
0: ADD ESS
�I 1 ` �t r • 1-�
�-7
CIT TELEPHONE
STATE LICENSE NUMBER CITY LICENS
223D1-13 29
Legal Description of Property (Show Below or Attach Fout
7
NEW
ADD
ALTER
REPAIR
RESIDENTIALI
NON-nESIDENTIAL
❑
❑
GAS
LINE
SIGN
NING
RETAINING
FENCE 7t.......... Ft.)
SWIM
POOL
❑
❑
R DEMOLISH
EXCAVATE
❑ ORFILL
❑ INSPhfOVE
LLL�JJ
iUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
❑ YES O NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
YES ❑ NO
OF
/ ✓ /��
Plan Check No.
Inc
BUILDING
PROPOSED USE
PLUMBING
O
aPLOT
PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
A
n
FENCE
SIGN
tRETAINING
WALL
N
ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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-
lzed 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
THIS PERMIT
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 IIUII.DIlr'GS shall be com-
pleted In six months.)
RE (OWNER O AG'N DATE SIGNED
INSPECTION
DEPARTMENT
PNATNOTE:
CITY OF
EDMONDS
Applicant tGjec to Plan Check Pee
PR 6-1101
This Permit covers work to be done on private properly ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
VERIFIED BY
Valuation
Ej YES 13 NO
N
C
W
m
No.
II.s'o k 406?
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.
FILE
I