670369.pdfBUILDING DEPARTMENT I
Applicant Fill
Inside Heavy IAncs
PERMIT APPLICATION
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NON-RESIDEI TIAL
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RETAINING
0
WALL
DEMOLISH
EXCAVATE
PENCE
ALTER
OR FILL
( ........ . x .......... Pt.)
REPAIR
El
PRE -MOVE
INSP.
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POOL
R or
DwELL`NG
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UNITS
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V_ 21
I hereby mknowlodge that I have read this application; that the In-
formation given is correct; and that I am the Owner, or the duty author.
ized agent of the owner. I agree to comply with city and state laws regu-
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
relating to WorkmeWX Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
a hpal be completed in nitlety days; MOVED -IN BUILDINGS shall be com-
;eted In stic months.)
NOTB: Appli"ytt Subject to Plan Check Fee
This Permit covers work to be done ou private property ONLV.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
I
YE13
NUMBER 670369
P% pi I a 5- ' -M j tj 1 .2 S_ ' /n I %
%/1;REET R/W PT.
; 13
PLAN ST. it/w-f�...rr.
4
Plan Check No ............ _
BUILDING
PLUMBING
HEAT & OAS LIKE
PENCE
r-K-Ki
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR PILL
TOTAL A31OUNT DUE
ATMNMON
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 0-1107
0 YES C3 NO
DEFICIENCY THIS PROPERTY
FeL
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-
Imowledged in space provided.
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