670072.pdf1
UILDING DEPARTMENT I ApplicantM11
PERMIT APPLICATION Inside heavy Lines
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rATE LICENSE NUMBER
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egal Description of Property (i
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El NEW
®.,RESIDENTIAL 0 tom
NON-RESIDENTL4.L
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ADD ❑❑ WALL
DEMOLISH
ALTER ❑ OR FILL ❑ PENCE
......... Ft.)
REPAIR PRE-INSPMOVE. SWIPOOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DO
Na
- aj'�O(7691
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EXISTING
STREET
R/W
...........FT.
COMP. PLAN
ST,
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Plan Check No..._...„.._._...
BUILDING
PLUMBnVG
HEAT d: OAS LINE
FENCE
BION
IRETAINING WALL
BWDSEIING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OA FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the to-
formatlon given is correct; and tbat I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
laung construction: and in doing the work authorized thereby, no parson
will be employed in violation of the Labor Code 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 to six months.)
NOTE: Applicarit Subject to Flan Check Fee
This Permit coven
work to
be done
on private property ONLY.
Any coustruction on
the public
domain
(curbs, aldowalks, driveways,
marquees,
etc.) win
require
separate permission.
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pit 0.1107
NEnmm
UMBER 6-70072
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DEFICIENCY THIS PROPERTY I „
Valuation
0,0
YES
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I
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- i
lmowledged in space provided.
DIRECTOR'S SIGNAT H -
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