730062.pdf' BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
• %one-ld �Ya�`(
V-SUILIF40 ADDRESS
I t-Il o N.w. Zs+j,
° CITY
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ADDRESS
4700 lBsiklv'A /41-�e AW
CITY TELEPHONE NUMBER
Se N 10. 17g3- tss 6
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NEW
ADD
ALTER
REPAIR
O he,
'oper,y tanow Celow or Atmca au,
S•e�v t•e� 'i'r'
C 00
RESIDENTIAL ❑GAS
LINE
NON-RESIDENTIAL F� BION
RETAINING
DEMOLISH WAIT'
❑EXCAVATE ❑ FENCE
OR FILL (........ ..x......... Ft.)
PRE -MOVE SWIM
INSP, POOL
DWELLING
UNITS D N
renllt✓
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-
tzed agent of the owner, I agree to comply with city and state laws regu-
lating construction; and In doing the work authorized theraby, no person
will be employed In v101atlan of the Labor Coda 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 -IN BUILDINGS shall be com-
pleted in six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY,
Any construction on the public domain (curbs, s'e•%ralkb driveways,
marquees, steel wW require separate lesion,
UBE PERMIT
ZONE NUMBER
REAR FRONT SIDE REAR
YES 0 NO PERMIT NUMBER
PLANNING DEPT, APPROVAL DATE:
EXISTING STREET R/W ,...........FT. DEFICIENCY THIS PROPERTY
COMP, PLAN ST, R/W ...........XT, ............Fr,
REMARKS
E-jAJ.MW 6 — /✓e C 6%)AG 1570
V ' L■f:L�7
am-
N THE CITY
SALES TAX
PLUMBING
HEAT k OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE I ( / �rJ/O 9
ATTENTION APPLICATIONAPPROVAL
"
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY WORK NOTED uty; and fees are paid, and receipt is ac-
know
kdged in space provided
INSPECTION
DEPARTMENT
OITY OF
EDMONDS
PR 6.1107
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