670167.pdf—7
LDING DEPARTMENT Applicant Fill
RMIT APPLICATION Jinside 11@avy Lines
NAME OF BUSINESS)
eARTCR
0
NEW
RESIDENTIAL
El
AS
GLINE
NON-RESIDENTIAL JF�
SIGN
ADD
El
RETAINING
WALL
ElALTER
0
DEMOLISH
EXCAVATE
OR FILL
FENCE
( x Ft.)
.......... ..........
E] REPAIR
1:1
PRE -MOVE
INSP.
SWIM
POOL
WUMBER '0F STORIES
NUAII34kC U11
DWELLING
UNITS
/9X ao
L __V_V�.
— �4X
I hereby acknowledge that I have read this application; that the In-
formation given In 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-
lating eonstructlon; aad In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
relating to Workman's Compensation Insurance -
NOTE: Permit Umit One Year (Except DE31OLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
3IONATURE (OWNER OR AGENT) DILTE SIGNED
10
NOTE: Applicant Stibject to Plan Check Fee
This Perndt covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveivays,
marquees, etc.) will require separate permission.
PERMIT
NUMBER
LCK REAR
VACAN
13 YES
ZA VARIA
)7016-1
W.,
STRIXT R1W
EXISTING STREET R/W ........... X T. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ Fr . . ............ IT.
or
0 YES
A
Plan Check No ...........
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
A=NTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
Valuation
Z
9
Ej YES
1 1,57� J_ 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-
knowledged in space provided.
FILE
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