670463.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION inside Heavy Lines
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POSTED ON KROLL MAP NO.:
103 f-
PERMIT 170463
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SIGN
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RETAINING
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REPAIR
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EXISTING STREET R/W _:�!' .-FT. DEFICIENCY THIS PROPERTY
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COMI-. PLAN ST. R/W 420 ... FT.
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PROPOSED USE BUILDING
-FL-0-T-PLAN (Indic to Building setbacks, a] utting streets) PLUMBING
0 Ir HEAT & GAS LINE
PENCE
SIGN
RETAINING WA.LL
SWIMMING POOL
DEMOLITION
Sr. sw.
PRE -MOVE INSPECTION
go EXCAVATION OR FILL
TOTAL A31OUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given In 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
laUng; construction; and In doing the work authorized thereby, no person
17
I hereby
ven
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In
formation � f the 0
zed agent
obstruction
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will be employed In violation of the Labor Code of the State of Washington THIS PERMIT
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;lating to Workmen's Compensation Insurance. AUTHORIZES
re ONLY TI[E
NOTE: Permit Limit One Year (Except DE31OLITIONS which JVORK NOTED
shall be completed in ninety d MOVED -IN BUILDINGS shall be com-
p PI I in s _ monu 77 INSPECTION
leted In sirtmonths.)
BIG W,
N (OWIk=-OR AG DATE SIGNED DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Permit covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks. driveways,
marquees, etc.) will require separate permission.
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Valuation I Fee
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APPLICATION APPROVAL
Viis application is not a perrait until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
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