670183.pdfI
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
CITY i LEPHONE NUMBER
Ed 0 wals ON. 'k—,F 7/,p
.2- 3 14 ;L- 3 / 5104- 1 3 z,5 1)
S__21U
, I �# Y. �44_1119?1-elt
IFF
SEAM=
P1�71
RESIDENTIAL
GAS
LINE
DNEW
I
NON-RESIDENTIPLL
SIGN
RETAINING
17
DEMOLISH
WALL
EXCAVATE
FENCE
ALTER
F�
OR FILL
( x Ft.)
.......... ..........
REPAIR
El
Pl(E-MOVE
INSP.
El
SWIM
POOL
NUMBER OF STORIES
NUMBER or
DWELLING
UNITS
NO.:
PERMIT
NUM13ER
W .
YES [3 NO
EXISTING STREET R/W ............ IT. DEFICIENCY THIS PROPB=Y
COMP. PLAN ST. R/W ............ FT. ........... 3T.
[:] YES
13 NO
Plan Check No .....................
BUILDING
AA
Alewro Builcling setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
7
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
STREET IMPROVI
0 YES [] NO
V /I
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin &PPliCatl0n: 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-
ATMNTION
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.
AUTIIOIUZES
NOTE: Permit Limit One Year (Except DE31OLITIONS which
01 THE
NLY
WORK NOTED
shall be completed in ninety days; 31OVED-IN BUILDINGS shall be com-
pleted In six months.)
rj—GNATURE (OWNER OR AGENT) DAT SIGNED
INSPECTION
FER
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
This Permit covers work to be done on private property ONLY.
Any construction an the Public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation Fee
I I,),. I a -1 -� 0
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.
.0
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FILE
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