750202.pdfF -A. -N-
G DEPARTMENT Applicant
APPLICATION Inside Heavy I
ME OF BUH1N )
is REee- STELEPHONE NUMIlk
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NADDRESS
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J
C CITY TI
NAME
Cd 2.�
GJ ADDRESS
C C7T'Y I T
STAT LICENSE NUMBER C
Legal Description of Property (dhow Below or
C
D
U
a
W
LE
F
Plan Check N0.1.47.......'.jr'
F LINE
NEW
BUILDING
�RESIDENTIAL
4 PROPOSED USE
NON-RESIDENTIAL
I7() 626N
ADD
FlDEMOLISH
Y❑—'`WALL ANG
ALTER
EAVATE
[:] FEN Cx
PLAN (Indicate Building setbacks, abutting streets)
❑ OR FILL
.......... Fl.)
REPAIR ❑ PRE -MOVE
F1P0OL
9P
FENCE
IUMHER OF BTORtEs NUMBER OF
SIGN
DWELLING
I
RETAINING WALL
UNITS ---�
N
IATU OF WORK ONE
LE
F
Plan Check N0.1.47.......'.jr'
BUILDING
4 PROPOSED USE
PLUMBING
aPLOT
PLAN (Indicate Building setbacks, abutting streets)
HEAT A: GAS LINE
m
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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t heresy acknowledge that t have read thl. application; that the 1n-
/ O
tormntlon given Is correct; and that I am the owner, or the duly author•
[zed agent of the owner. 1 agree to comply with city and state law' ""ATTENTION
APPLICATION
luting construction; and In doing the work authorized thereby, no person
APPROVAL
will be employed In violation of the Labor Code of the Stale of Washington
TIUS PERMIT
This application is not a permit until
relating to Workmen'' Compensation insurance.
AUTHORIZES
eigned by the Building Official Or his Dep.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
Ut and fees are 61dr and receiptie 6C -
y: P
shall be completed in nlnely day.; MOVED -IN BUILDINGS shall be Som•
WORK NOTED
knowledged In space provided.
Pleted In six months.)
SIGNATURE (OWNER OR AGENT) DAT BIG NEll—
INSPECTION
DIRECTOR'S a ON U E
3 / r
DEPARTMENT
cGJ
CITY OF
NOTE: Applicant thject to Plan Check Fre
EDMONDS
DATE L
Thi. Permit rovers -,k to be done on prlvate property ONLY.
775-2525
Any ren.trnrllon nn the puirlle dmm�ln ten't's, nlAewniks, drtyew'.ys,
,r'lerr�, rtr.).., ill riyulrr nelmnrtr I,rrrol..lnn.
FILL:
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