720344.pdf. BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
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CITY
NAM
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Applicant M
Inside Heavy Lines JOB ADDRESS
BIDE YARD 8E
USE ZONE
MPHONE NUMBER
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Legal Description of rroperty (snow SeWw or Altaan Four CODIee)
�TY'CcCT S Ri K . 000 D06
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❑RESIDENTIAL ❑ OAS NEW LINE
❑ NON-RESIDENTIAL ❑ SIGN
❑ ADD ❑ DEMOLISH ❑ WALLNIN6
ALTER EXCAVATE FENCE
❑ OR FILL ❑. (....... .x ......... Ft,)
❑ REPAIR PRE -MOVE swim
❑ INSP. ❑ POOL
N MBER OF STORIES NUMBER OF
DWELLING
UNITS
Pa �-t al
PROPOSED USE
QPLOT PLAN (Indicate Bullding s,
OIn
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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 rellu-
lattur construction; and In doing the work authorised 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 Your (Except DEMOLITIONS which
shall be completed In ninety days; MOVED•IN DUnMINGS shall be com-
pleted In six months,)
NOTE:
Applicant Subject
to Plan Check
Fee
This Permit covers work to be done on private property ONLY,
Any construction an the public domain (cuI sidewalks, driveways,
marquees, ate,) win require separate permission,
STREET R/W
EXISTING STREET R/W ....,.,.....FT,
COMP. PLAN ST, R/W ............Fr.
Plan Check No,......._.._..»...
alipiAP let.II
I4-Ailyi-IR •1
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
19-AXICI)AYJ@}il
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
PERMIT
NUMBER
THIS PROPERTY
IS SITE IS LOCATED IN THE
CITY OF EDMONDS, LOCAL SALES
TAX SHOULD BE CODED 31.040
Valuation
*df
Fee Receipt No.
ATTENTION APPLICATION APPROVAL
TIDS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided,
INSPECTION I
EDMONDS Dw E B S! ATURE
DEPARTMENT
CITY OF
F%k
PR s-1107 ` _ MZ_7_ _
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