670209.pdf0
BUILDING UtrAttiffitNI
PERMIT APPLICATION_
Applicant Fill
Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
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CITY
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NAME
ADDRESS
CITY
TE PHONE NUMBER
NAME
ADDRESS
CITY
TE�MONE NUMBER
85�AMTE :,ICENSE NUMBER--
CiTY—aC—ENSENUMBER
PERMIT
NUM13ER 670209
5�;' 1 1 [3 YES
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NG STREET R/W ............ FT, DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ Fr. ........ ... 17. —
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DEMOLISH
WALL
ALTER
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EXCAVATE
OR FILL
17
FENCE
( .......... x .......... Ft.)
REPAIR
Q
PRE -MOVE
INSP.
El
swim
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
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Plan Check No .....................
PROPO T'/41/1
BUILDING
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PLOT P�,AN (Indicate Builaing setbac", aDuttinr
PLUMBING
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HEAT & GAS LINE
PENCE
SIGN
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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 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 regu-
ATTENTION
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 PER1%IIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except Dr-tIOLITIONS which
WORK NOTED
shall To completed in ninety days! 31OVED-IN BUILDINGS shall be com-
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pleted in six months.)
U It A I —DATE SIUNFD
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INSPECTION
DEPARTMENT
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CITY OF
EDMONDS
N TE: Applicaf(t Subject to Plan Check Fee
PR 6-11011
TIA, permit coveys work to be done on private property UINIA.
Any constrnctlOn on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
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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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