670405.pdfCW:.
BUILDING DEPARTMENT
PERMIT APPLICATION
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I�MA.�rDS I743—
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ACA P« lT Yo 4. S_'
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RESIDENTIAL D �
NHIW E
NON-RESIDENTIAL SIGN
ADD DEMOLISH RETAINING
ALL
ALTER OR EXCAVATE
PILL FENC.x.......... Ft.)
REPAIR IRE-MOYffi SWIM
POOL
NUMBER OF STORIES NUMBER OF
DWELLING (J� UNITS ep/o
AN,D
/ b.2a a
EXISTING STREET R/W ...........FT.
COMP. PLAN ST, R/W ............FT.
mum
❑ NO
Plan Check No ... ...........
BUILDING
PLUMBING
HEAT d: GAS LINE
FENCE
was SIGN
II RETAINING WALL
in f SWIMMING POOL
y �•t � DEMOLITION
` 1 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• ATTENTION
lauug 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
relating to Workman's Compensation Insurance, AUTHORIZES
NOTE; Permit Limit One Year (Except DEMOLITIONS which WORRKYNOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
IIGNA RE (OWNER R AGENT) DATE SIGNED INSPECTION
!� 7 DEPARTMENT
�y CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 8-1107
This Permit coven work to be done on Private Property ONLY.
Any Construction on the Public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Oo
VACANT SITE
13 YES ❑ No
VARIArrCE NUMBER
Y: �
Fee
7r s0 139vr
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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