670058.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
VAM�MOR NA?dE DUSI Sal
Z
WAILING ADDRESS
S_
N,
AJ
a
N
C
Z
8
I/
Applicant Fin
Inside Heavy Lines
PIDRMIT
N'UMBER
-7
USE ZONE OT AREA VA -CANT SIT15-10
[3 YES 13 NO
ow
EXISTING STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ F-r- ...... .... 1".
!ffM_ARKS
ICHECKED BY tZZ
I N
[] YES
MA/
RESIDENTLA
GAS
LINE
NEW
NON-RESIDI TIAL
F-1
SIGN
RETAINING
ElDEMOLISH
WALL
ALTER
0
EXCAVATE
OR FILL
0
FENCE
( .......... X .......... Ft.)
0 REPAIR
F-1
PRE -MOVE
INSP.
Ej
SWIM
POOL
ES
NUMBER OF
DWELLING
UNITS
0 NO
Plan Check No ............ . .......
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL ABIOUNT DUE
I hereby acknowledgo that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
A
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
TIUS PE101IT
relating to Workman's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit Otte Year (Except DEMOLITIONS which
WORK NOTED
I
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIGNATURE tvw� OR AGWT) DATE SIGNED
INSPECTION
DEPARTMENT
I
OITY C
EDMONDS
NOTE: Applicant Subjcct to Plan Cbeck Fcc
PR 0.1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewulks, driveways,
marquees, etc.) will require separate permission.
I
E] TE13 E] No
Fee I Receipt No.
0 0
APPLICATION APPROVAL
This application is not a permit until
signed by the Building official or his Dep-
uty; and fees are pald,�'.,,and receipt Is ac-
Imowledged in space.ptovided.
DIREO Is JBIGNA
jPK
WJ
DATE
3
FILE