670147.pdf........... .... .. .
BUILDINO DIIARTMINT Applicant Fill
Inside Heavy Lines
PERMIT APPLICATION
NAM %OR NAME OF BUSINESS)
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P t A CE
5110148
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CITY
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NAME
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QUO
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if
or
C
2 RESIDENTIAL
El
AS
GLINE
0 NEW
NON-RESIDENTIAL
SIGN
ADD
RETAINING
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
PENCE
I .......... x .......... Ft.)
REPAIR
PRE -MOVE
INSP.
swim
POOL
NUMBER OF
DWELLING
UNITS
C'LaSE IN CAR F_U
)LL MAP NO.: PERMIT
N BER
I UM 670147
A�
1Z
0
0 YES 0 NO
PERTY
EN38TING STREET R/W ............ FT. DEFICIENCY Tills PRO 01
COMP. PLAN ST. R/W ............ FT- ............ FT .
REMAr.K8
METER SIZE I SERVICE SIZE I CLEARANCE CHECKED By
REMARKS
FIRE
[] YES [] NO
IPlan Check No .........
PROPOSED USE
BUILDING
PLOT PLAN (IndicTte Build-Ing Betbaell-9, abutting streets) PLUMBING
M IHEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
r�r,-lnvv� 111o�
EXCAVATION OR FILL
TOTAL A31OUNT DUE
at t h
I hereby acknowledge that I have read this application; that the In-
ly an or
formation given Is correct; and that I am the owner, or the duty author.
sw re gu-
ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
no
lating construction; and in doing the work authorized thereby, no person
PC no'
la'bil gton
will be employed In violation of the Labor Code of the State of Washington
Tius PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY TBE
hich
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall he completed In ninety days; MOVED4N BUILDI.NGS shall be com-
pleted in six months.)
0 E
TURE/V7 0 DZE SIGN ED
INSPECTION
DEPARTMENT
CITY OF
V
EDMONDS
NOTE: Applicant Subject to Plan Chech Fee
PR 0-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) nill require separate perruisslon.
0 0-
[j YES [] NO
Fee
'5-
KM
1 5-. C) 0 1
APPLICATION APPROVAL
This application is not a perinit until
Signed by the Building official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
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