670149.pdfA
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POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fill NMI13ER 670149
PERMIMI! E
T APPLICATION Inside Heavy Lines J013 ADDRESS
FIBN!AM4 479R NAME OF BUSINESS) /11 q �31 ?w Al 4
SIDE YARD SETBACK STREET 0
'MAILING AD"....
LOT AREA
USE
TEL�PIIONE NUMBER
CITY 1� / ;, I
-7—
;7Z 7
12
TELEPH?,N�
2-3 — 0/ —4;k 3
_Z_
RESIDENTIAL
GAS
LINE
NEW
WTIAL
NON -RESIDE
IGN
ADD
RETAINING
r]
WALL
DEMOLISH
ALTER
EXCAVATE
PENCE
Ft.)
OR FILL
( .......... x ..........
REPAIR
PRE -MOVE
INSP.
ED
SWIM
POOL
1:S
NUMBER OF
DWELLING
UNITS
to
E3 NO
=08;REET R/W 9�_!Z.JPT. DEFIC=CY TMS PROPERTY
COMP. PLAN ST. R/W ... Af.ex1r. .....
ci
FtC. TEST PERZ= NIT.
-7-7
I I [] YES E3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES QNO
PLAN , CHECKEDBr
Plan Check No ........ ............
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
t SiON
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
I hereby acknowledge that I have read this 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- AT=NTION
la,ting construction; and In doing the work authorized thereby. no person
will be employed In violation of the Labor Code of the State of Washington Tlus rERMIT
relating to Workmen's Compensation Insurance. AUTHOMZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which JVORK NOTED
shall be completed in ninety days; ItIOVED-IN BUILDINGS shall be com.
pleted in six months.)
110, A ER NT) DATE SIGNED INSPECTION
DEPARTMENT
J CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
7ildis penoR covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
rriu,quees, etc.) will require separate permission.
Valuation
Fee
PW
Z
W
,7
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.
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