670246.pdfC.
—;'o'wrE:DON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT I NUMBER
Inside HeavY Lines JOB ADDRESS
PERMIT APPLICATION I 'Ies I
i
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NAME
P�WT AP ROVED
�PILAANN
AD
R/W
=G STREET R/W ............ FT. DEnciENcy THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ...........
0
CITY
TELEPHONE N UMBIM
TCF_�_S
HAMM
N�'
Z
CHECK ED BY
METER SIZE SERVICE SIZE CLEARANCE
CHEOMM BY
TELEPHONE NUM
REMARKS
or
RESIDENTU
',
GAS
LINE
NEW
NON-RESID� TIAL
r_1
SIGN
RETAINING
0
DEMOLISH
0
WALL
ALTER
0
EXCAVATE
OR FILL
FENCE
( ........ . X .......... Ft.)
REPAIR
1:1
PRE -MOVE
INSP.
F-1
swim
POOL
TUMBER OF STORIES
NU31MR OF
DWELLING
UNITS
ninsil
1:1M
WAS
(A It
NO
X
S 04-
[] YES
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
0
t
FENCE
SIGN
RETAINING WALL
SWIM No POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCXVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this &PPI1c&U0n; 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-
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 PERMIT
r@ILtIng to Workman's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted
,In W90
RG 0 OR AGE DAT3Y SlUrif LJ
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
LAOTE: Applijant Subject to Plan Ojec
Pit 6-1107
%W Perndt covers jVork to be done on privat p rty ONLY
Any construction on the public domain (curbs, a an-alks, driveway,,
marquees, etc.) will require separate emission.
Valuation
[] YES
Fee
No.
1/00-- �" 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.
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