670321.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLI Inside Heavy Lines
-1ZNAMIC (OR NAMM OF BUSINESS)
20.41,1P�C & 16�1wree
�,q 70
or
NEW
M
L/�j RESIDENTIAL
1
F _1 I
GAS
LINE
1:1 NON-RMSIDENTIAL
SIGN
ADD
MDEMOLISH
RETAINING
WALL
EXCAVATE
PENCE
ALTER
F-1 OR FILL
I X Ft.)
REPAIR
PRE -MOVE
1:1 INSP.
.......... ..........
swim
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Z
0
t
NO.: PERMIT
NUMBER
USE ZONE LOT AREA VAclUff SITE -
I I [] YES 13 NO
RRInHT FRUILDING AJUDA 1 VARIANCE NUMBMK
EMS77NG-STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ Fr.
REMARIKS
0
ICRECKED BY 1Z
[] YES 0 No
[] YES [] NO
I -
Valuation I Fee
Plan Check No ................
2
BUILDING
E�VO
0 0
PLUMBING
BEAT & GAS LINE
PENCE
SIGN
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 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. AWENTION APPLICATION APPROVAL
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 This application is not a permit until
relating to WorkmeWe Compensation Laurance. AUTHORIZES
ONLY THIS signed by the Building Official or Ills Dep-
NOTE: Permit Limit one Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt Is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com- knowledged in space provided.
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED INSPECTION DIRE �08 IG
ONA
DEPARTMENT
7 e16 CITY OF
EDMONDS DATE
NOTE: Applicant Subject to Plan Check Fee rn 0-1107
This Permit covers work to be done an private property ONLY.
Any oDuAroction. an the public domain (curbs, sidewalks, drivewayst FILE
marquees, etc.) will require separate permission. r
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