670377.pdf. ... ......
BUILDING DEPARTMENT Applicant FIR
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PERMIT APPLICA1
NAME OF BUSINESS)
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ON JJMOLL MAP NO.: PERMIT
NUMBER b
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[3 YES [] NO
EXISTING -STREET R/W ............ FT- DEFICIENCY THIS PROPERTT
COUP. PLAN ST. R/W ............ FT. . ........ ... 117.
or
0 YES 0 NO
D RESIDENTIAL
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NEW
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NON-RESIDENTIAL
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SIGN
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RETAINING
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DEMOLISH
EXCAVATE
FENCE 1,
ALTER
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OR FILL
(6jD X.1- Ft.)
REPAIR
1:1
PRE -MOVE
INSP.
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POOL
iUMBSR OF STORIES
NUMBER or
DWELLING
UNITS
or
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Plan Check No .....................
P In C It k
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BUILDING
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PLUMBING
P L U
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V INS CTION
RE -MOVE INSPECTION
P P11 Mo M PE
CAVATIO OR rILL
EXCAVATION OR MLL
TOTAL AMOUNT DUEU
TOTAL. JOUNT
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 au=w-
Ized agent of the owner. I agree to comply with City and state laws r'CgU- ATTENTION
lating construction; and In doing the work authorized thereby, no person
'y N I I
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will be employed in violation of the Labor Code of the State of Washington THIS PERMIT
relaUng to Workroca'a Compensation Insurance. AUTHORIZES
ONLY TILE
which
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be compl.eted In ninety days; MOVED -IN BUILDINGS shall be Conn.
pleted In six months.)
TATU (OWNER OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fec PR 6-1107
This Pemat covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewnJks, driveways,
marquees. etc.) will require separate permission.
Valuation
0111,
BY
13 YES [I NO
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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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