670550.pdfBUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION inside Heavy Lines
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NAME
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ADDRESS
CITY _J,�TM.LMEPHONE NUMHU
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ADDRESS
CITY TELEPHONE NUM33ME
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NEW
RESIDENTIAL
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GAS
LINE
NON-RESIDENTIALI
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SIGN
RETAINING
17
WALL
ALTER
DEMOLISH
EXCAVATE
FENCE
n
On FILL
( .......... x . ........ Ft.)
REPAIR
1:1
PRE -MOVE
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swim
POOL
INSP.
NUMB7 OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORISTb—BE DONE
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-
lattrig 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 Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE31OLITIONS which
shall be completed in ninety days; MoVED-IN BUILDINGS shall be com-
pleted In six months.)
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NOTE: Applicant Subject to Plan Check Fee
--ib—is Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will reQuIrc separdle permission.
PERMIT
NUMBER 6 /L
1-4 f A�5-�f t- t_�n� 11 0
USE ZONE LOW AREA VAUANW OXXM
ffl ) 1 13 YES
RRICtFIT I BUILDING AREA I V,
CSTIKG STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
rA.
YES wrq�a
:Ilan Check No
DEFICIENCY THIS PROPERTY
...... -FT.
Valuation
YES
No.
BLTILDING
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PLUMBING
BEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE I
L,�-.z 1
ATTENTION APPLICATION APPROVAL
TIUS PERMTT This application Is not a permit until
AUTHORIZES
ONLY THE signed by the Building official or his Dep-
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION —DIRECTOR'S IG14A
DEPARTMENT
CITY OF
EDMONDS
Pit 6.1107
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