710431.pdfJ POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fill I NUMBER
PERMIT APPLICATION
Inside Heavy Lines JOB ADDRESS
NAME (on NAME OF BUSINESS) n
urns, wean armaAr.,c , STREET SETBACK I REAR YARD
W
T'
c
/)S
NEW
RESIDENTIAL
❑
LINE
NON-RESIDENTIAL
❑
SIGN
ADD
❑
❑
RETAINING
DEMOLISH
ALTER
❑
EXCAVATE
ORFILL
❑
FENCEx......... Ft.)
ElREPAIR
❑
INSP.
.
SWIM
rUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES ❑ NO
❑ YES ❑ NO
DEFICIENCY THIS PROPERTY
❑ YES ❑ NO
PLAN CHECKED BY THIS SITE IS LOCATED IN TH
CITY OF EDMONDS. LOCAL SAL
REMARKS TAX SHOULD BE CODED 31.0�
Plan Check No ............. .......
POP ss a t'T- CSD
jPO'1unn
f . v
W
BUILDING
E
PLUMBING
rj
q
a
PLOT PLAN (Indlcnta Building setbacks, abutting streets)
HEAT do GAS LINE
FENCE
O
SIGN
RETAINING 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 1s correct; and that I am the owner, or the duly author-
Ired agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
lating construction; and in doing the work authorised thereby, no person
will be employed in violation of the Labor Code of the State of Waabington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In elx months.)
SIGNATURE (OWN OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
7�
CITY OF
'Applicant
EDMONDS
N E: Subject to PlanCheck Fee
PR 6-II07
This Permit covers work to be done on private property ONLY.
Any construction on the public domain lcurbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
Fee
No.
�z" 6a15
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.
/1z.
DATE 9117- 71 ., Ok
FILE
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