670557.pdfBI I LD I DEPARTMENT
Applicant Fill
inside Heavy Lines
NO
Att IT APPLIC
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TELEPHONE NUMB
FDAMAIP50
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CITY TELEPHONE NU
CPA
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TELEPHONE NUM
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111
Lj RESIDENTIAL
NON-RESIDENTIAL
M
MDEMOLISH
MALTER
EXCAVATE
Fl
OR PILL
REPAIR
R
PRE -MOVE
INSP.
DWELLING
UNITS
K=E
SIGN
RETAINING
WALL
PENCE
( ........ x .......... Ft.)
swim
POOL
I hereby acknowledge that I have read this application; that the in-
formaUOU given 18 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-
lating eonatmetion; 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 Workman's Compensation Insuranct -
NOTE: Permit Limit One Your (Except DEMOLITIONS which
shen be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
;IGN X NT DATE SIGNED
oe
N6TE: Applicant Subject to Plan Check Fee
This P retit covers work to be done on Private Property ONLY -
Any construction on the Public domain (curbs, sidewalks, driveways,
marquee#, etc.) will require separate permission.
.OLL MAP NO.:
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EXISTING STREET R/W ............ FT.
COUP. PLAN ST. R/W ............ IT -
C3 YES
NO
Plan Check No ...........
BUILDING
PLUMBING
BEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 0-1107
PERMIT
NUMBER 670557
S -
VA—cANT SITE
El YES E-3 NO
VARIJALNCE NUMBER
DEFICIENCY THIS PROPERTY 0
.......... M. I a
IR
Tmmwi7y N
[] YES [] NO
Valuation I Fee
I -3,vo 1414
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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