670053.pdfI,UILDING DEPARTMENT Applicant Fill
IMERMIT APPLICATION Inside Heavy Lines
�NAMV (OR NAME OF BUSINESS)
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TELEPHONE NUMBER
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94 ADDRESS
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CITY
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STATE LICENSE NUMBER
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Legal Description of Property (Show I
"P441.1n131"V6-
TELEPHONE NUMBEI
CITY LICENSE NUMB
low or Attach Four Copies)
RESIDENTIAL
El
GAS
LINE
NEW
NON-RESIDENTIAL
SIGN
ADD
RETAINING
WALL
DEMOLISH
EXCAVATE
FENCE
ALTER
OR FILL
( X Ft.)
EIREPAIR
1:1
PRE -MOVE
E]
.......... ..........
swim
INSP.
POOL
;UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
. . . . . . . . . . .
ON KROLL MAP NO.: PERMIT
I NUMBER 6
DRESS
?,33 96
ARD SETBACK I STREET SETBACK I REAH
[3 YES
EXISTING -STREET R/W ............ FT. DEFICIENCY THIS PROPE RTY
COUP. PLAN ST. R/W ............ FT. .......... FT.
REMARKS
0 YES 0 NO
Plan Check No ............
OF
BUILDING
PLUBMNG
HEAT & GAS LIIM
PENCE
t SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL LAMOUNT DUE
I hereby acknowledge that I have read thin 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 Workman's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; 31OVED-IN BUILDINGS shall be com-
pleted in six months.)
7
NOTE: Applicant Sisbica to Plan Chcck Fcc
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) ivill requke separate permission.
ArMNTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
CHECKED BY 1-4
Z,
0 YES 0 NO
Fee I Receipt No,
APPLICATION APPROVAL
This application Is not a permit until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
I