670192.pdfPOSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fill NUMBER 670)92 r
Inside Heavy Lines JOB ADDRESS
RMIT APPLICATION
�.JOR NAME OF BUSINES"
,�� 6,2. �; - -�- / -2- , 'S
or
VACANT ME
[3 YES 13 No
VARIANCE NUM ER
EN38TING-STREET R/W ............
FT. DEP701MCY THIS PROPERTY
INY NUMBER
0
COMP. PLAN ST. R/W ............
FT.
REMARKS
CHECKED BY
0
Z
METER SIZE SERVICE SIZE
CLEARANCE CHECKED BY
)NE NUMBER
I
I
1
15
REMARKS
:ENS19 14UAMXBER
C] YES [:I NO
Li
RESIDENTIAL
GAS
LINE
EINEW
NON-RESTDENTIAL
SIGN
ElDEMOLISH
0
RETAINING
WALL
E-1 ALTER
0
EXCAVATE
OR FULL
1:1
PENCE
( x Ft.)
REPAIR
F-1
PRE -MOVE
INSP.
1:1
.......... ..........
SNVIM
POOL
IUM13ER OF STORIES
NUMBER OF
DWELLING
UNITS
OF
Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
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 to 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 r6gu-
ATTENTION
luting construction; and In doing the work authorized thereby. no person
will be employed in violation of the Labor Code of the State of Washington
TIUS PERMIT
relating to Workmen's Compensation Insurance.
AUTHOIUZES
NOTE: Permit Umit One Year (Except DEMOLITIONS which
014LY THE
WORK NoTzD
shall be completed In ninety days; IMOVED-IN BUILDINGS shall be com.
n six months.)
(OWN OR AGENT)
DA NED
INSPECTION
eIGNXURE
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
Pn 6-11117
This Permit covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate permission.
0 YES E3 NO
Valuation I Fee
-us,
.3.0 0
RM
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.
DmEqTO�VS SIGNATURE
. ��7 �
-I / -
FILE 1q rF
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