710411.pdfBUILDING DEPARTMEIVT AppllcantFill
PERMIT APPLICATION Inside heavy Lines
NAME (OR NAME OF BUSINESS)
Q ,yS ONE _7W9/F72vfi y
MAILING ADDRESS
r"29 —/00
CITY TELEPHONE NUMBER
Morlel.5
NAME
4�7 ADDRESS
E�yy
CITY TELEPHONE NUMBER
NAME
t N S/ bN o
i 0:1 ADDRESS
1, CITY I TELEPHONE NUMBER
STATE LICENSE NUMBER CITY LICENSE NUMBElt
cvals - v a -
Legal Description of Property (Show Below or Attach Four Copies)
.LDT-3 - Ste- is &�/�.i
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NEW
RESIDENTIAL
ElL
LINE
ElADD
IX
NON-RESIDENTIAL
T
�I�I❑��
BION
❑
DEMOLISH
RETAININGL
ElALTER
AVATE
PENCE
El
ORCFILL
❑
xFt.)
REPAIR
0
PRE -MOVE
INSP.
..........
SWIM
POOL
;UMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
'OOTED ON KROLL MAP NO.: PERMIT 710411
] I O A
4 NUMBER /
OB ADDRESS c�
0202 CT ,2 /O O �'�' �t►t� t� o
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
Va All i:nr:,:nau ni THIS SITE IS LOCATED IN TH
CITY OF EDMONDS. LOCAL SAI
REMARKS AX SHOULD BE CODED 31.0
Z7 ° REV ISto0 6F U_.r2�h)er__0
1J0 SAGXI 1 AMU
Plan Check No .....................
BUILDING
PLUMBING
HEAT & OAS LINE
FENCE
SIGN
TRETAINING
N
WALL
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-
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 PERMIT
relating to Workman's Compensation Insurance.
AUTRORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall he completed In ninety days; MOVED -IN BUILDINOB stall bs Com-
pleted In six months.)
316NATURE (OWNER Olt A6ENT) DATE SIGNED
INSPECTION
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DEPARTMENT
CITY OF
ED51ONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
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.
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RECORD OF INSPECTIONS - 4
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Date Passed '
----
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_ Furnace & Fuel Lines
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qI ILD-0F INSPECTIONS
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