710524.pdfBUILDING DEPARTMENT ApplicantFul
PERMIT APPLICATION Inside Heavy Lines'I
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NAME (OR NAME OF BUSINESS)
,�W / 4� // ,5 U 5 /-/
MAILING ADDRESS
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CITY TELEPHONE NUMBER
9
'OE01vo A/� s 1724 -7 7 ZNAME
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ADDRESS
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CITY TELEPHONE NUMBER
�--/ lvoly_s 7 7 172 C-/
NAME
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ADDRESS
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CITY TELEPHONE NUMBER
NS I -72, -i727
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—Legal Description of Property (Show Below or Auacn &our cope
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NEW
FJ RESIDENTIAL
GAS
LINE
❑
NON-RESIDENTIAL
❑
SIGN
® ADD
RETAINING
❑
DEMOLISH
ALTER
❑
EXCAVATE
FEN CE
Ft.)
ORFILL
........ ..x..........
❑ REPAIR
❑
PRE -MOVE
INSP.
r
swim
POOL
DWELLING
UNITS
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 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; MOVED-DN BUILDINGS shall be com-
pleted In six months.)
/ 1 i01zy7/7,
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permLalon.
ROLL MAP NO.: I PERMIT —
NUMBER
;ETBACK I STREET SETB Cr I REAR YA
5� 2
I LOT AREA I VACANT I
YES
i
i
;TBACK
NO
IBER
a,
I
i
SCItGEW n/tv
EXISTING STREET R/W �r FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W a.C.)..FT. ....�.... FT. 0
REMARKS
.ro EU(R.i2(q' -
Driveway slopes not to e,:ceed those indicate
on Standard Drwain^ =103. CHECK BY w
METER SIZE SERVICE SIZE CLEARANCE CHE KE B�
REMARKS
a.
.
PERMI UF.1B
❑ YES 13 NO
❑ YES ;rSNO
PLAN CHECKED BY THIS SITE IS LOCATED IN THIT
lNei CITY OF Enu()p1DS�a^-?�
REMARKSTAX SHOULD BE CODED 31,04
1—�R- $�Pay�TtorJ �c-o..P
Plan Check No ...............
BUILDING
PLUMBING
HEAT d: OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
,EXCAVATION OR FILL
Valuation
S'
No.
DUE
I
I/ 16t66L�?t)
rTOTALAMOUNT
ON
APPLICATION APPROVAL
IT
This application is not a permit until
ES
signed by the Building Official or his Dep-
ONLY But
and fees are paid, and recei t is acED y� p
knowledged in space provided.
INSPECTION DIRECTOR' NAT
DEPARTMENT /
CITY OF ,
EDMONDS DATE
PR e-1107
FILE
S
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