670527.pdfBUILDING DEPARTMENT Applicant 11111
PERMIT APPLICATION inside Heavy Lines —j
NAME (OR NAME OF BUBINNUB)
A A1T_)C-W.S"VA1
('-) , [3 0 x S35,
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F!1000�
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Legal Description of Property (Show Below or Atta= Your Copies)
Z
6X L1_— :W= I J� P) am&� 5.6�
V
GAS
NEW RESIDENTIAL F1 LINE
NON. F SIGN
ADD ro ___ �17AINING
DDEMOLISH WALL
DALTER EXCAVATE PENCE
OR Fn-1 ( ........ . x ......... Ft.)
E] REPAIR PRE -MOVE swim
INSP. POOL
NUMBER OF STORIES
NU31BER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
2.
W
N�
I hereby Aclunowledge 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-
I&tLng 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 Workmenm Compensation Insurance.
NOTE: Permit Cimit One Year (Except DE31OLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
114-4 7'
NOTE: APPlicant Subject to Plan Check Fee
This Permit covers work to be done on private Property ONLY.
Any construction on, the public domain (Curbs, sidewalks, drIV&WSYB,
marquees, etc,) will require separate permission,
it" No.: PERMIT
. ,/," I NUMBER
.:2 C) 0'A
YARD SETI
$ I— -
STREET R/W ....... .... FT. DEFICIENCY
a 1 .-3/,*"
E3 YES
Plan Check No...
BUILDING
PLUMBING
BEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIV NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DOE
ArMNTION
THISPERMT
AUTHOIUIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CIETY OF
EDMONDS
PR 6-1107
PA
670527
ILLLI-q-
i� �YARD �SET
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is PROPERTY
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9
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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