670150.pdfPOSTED ON KROLL MAP NO.:
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines j(.)Ij ADDRESS
NAM (OR NAME OF BUSINESS)
YV
CITY
I
16�41 e
. 1 1 �7 S
-1- 2- 3, - L9 L/ W,
CITY
0 11 0/5 wps�
STATE LICENSE NUMBER
Legal Description Of Property (Shov�
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or A
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MC—ENSIUNUMI
14 if
NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
SIGN
RETAINING
WALL
ALTER
F-1
DEMOLISH
EXCAVATE
OR FILL
EK
N E
x...
7 ....
R REPAIR
Q
PRE -MOVE
INSP.
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POOL
LES
NUMBER OF
DWEI-T-T G
UNITS
0 YES 0 NO
EXISTING STREET R/W ............ FT. DEFIGIMOY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT -
TYPE OF
0 YES 0 NO
Plan Check No .....................
[] YES Ej NO
Fee
I
Z
N
No.
BUILDING
PLUMBING
5-, 0 0
HEAT & GAS LINE
PENCE
/6-0,0 0
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT 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 allee to comply with city and state laws regu-
AT=NTION
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
THIS PERMIT
relating to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ONLY 171E
WORK NOTED
shell be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
rI—ONATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
a/, 5-- a
CITY OF
EDMONDS
NOTE: Applicant Subject to Plat; Check Fee
PR 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways.
marquees, etc.) will require separate permission.
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 Re-
Imowledged in space provided.
FILM