710518.pdfFBA
N KROLL MAP NO.: PERMIT I
., BUILDING DEPARTMENT Applicant Fin I NUMBER j I �) `1 i 3
_ PERMIT APPLICATION Inside Heavy LinesESS
NAME (OR NAME OF BUSINESS) ,., yn — ��.� a-` ;
l ii I L L I A A A.�2 4W t
U
M
MAILING ADDRE88
7,90 5 /,9 2
CITY
1--fl44v a&5
TELEPHONE NUMBER
774-.92 6 V
wnDltEea S J 8 C t 4i k-� %Fk'f� I<
Plod F FINI s/f._
Legal Description of Property (Snow below or Atmcn &our uoy,ee)
of S% ery V #- 2l`f e. 3
d
119 -ore Of
Vlb-15 . 0au_P /2 l , 'ee &YJ5 4-
NEW
ADD
ALTER
❑ REPAIR
iL �Z
op
S -- W
6—
❑ YES
NO
EXISTING STREET R/W �..FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/WSQ..FT. •••• ••DT•
REMARKS Driveway slopes not to e::ceed those
indicated on Standard Drawin,i'M3.
❑ YES ❑ No
® RESIDENTIAL
NON-RESIDENTIAL
❑
❑
GAB ❑ YES �NO
LINE PLAN CHECKED BY
SIGN !eAj
I J . /
THIS SITE IS LOCATED IN T
CITY OF EDMONDS. LOCAL S)
DEMOLISH
EXCAVATE
ORFILL
RETAINING REMARKS
WALL
PENCE
......... z..........Ft.) �• ' A/�Z�
TAX SHOULDBE CODED 31.
aWt _
PRE-MOVE
INSP.
^n
L1
swim
POOL
NATURE OF WORK 7
Tv Car
Z block lulls,
PROPOSED UBE
Q I4MA
Q PLOT PLAN (Indicate
5
"1 6'eX,-'
DWELLING •- UNITS �jG ay- b
••(
BE DONE
'a Y a Z
!O 7' r�oo
a %f afrl� hl tht,
t
N
I
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-
Ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and in doing the work authorised thereby, no Verson
will be employed In vlo)atloc of the Labor Code of the State of Washington
relating to Workmen's Compensation Imurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant(,rSubject to Plan Check Fee
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 permisslon.
Valuation
Plan Check No .....................
BUILDING
PLUMBING
HEAT A OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Fee
TOTAL AMOUNT DUE
I
I 'SQL
16�
ATTENTION
APPLICATION APPROVAL
THUS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or Ma Dep-
THE
ORK NOTED
ut and fees are paid and receipt is ac-
knowledged in space provided.
INSPECTION
D tECTOR!Sj 13IONATiaW
DEPARTMENT
CITY OF
DATE
EDMONDS
PR 6-1107
0