670588.pdfC
BUILDING DEPARTMENT Applicant M
PERMIT APPLICATION Inside Heavy Lines
NAMM (OR NAME OF BUSINESS)
City of Edmonds
MAILING "DRESS
250 - 5th Avenue North
CITY TELEPHONE NUMBER
Edmoads, Wn. Pr. 6-lio?
i Description of Property (Show Below or AURCII wour uopici
South 1/2 of Lot 10 - East Edmonds
Acres
We
PERMIT '70588
NUMBER 6
13 YES 13 NO
EXISTING-BTREET R/W DEFICIENCY THIS PROPERTY
COUP. PLAN'ST. R/W ....... .... FT. ... . ....... In.
I
OF CONSTRUCTION
NEW
ADD
ALTER
REPAIR
RESIDENTIAL
NON-nESIDENTLJLL
DEMOLISH
EXCAVATE
ORFILL
PRE -MOVE
INSP.
GAS
LINE
SIGN
RETAINING
WALL
PENCE
( ......... �x .......... Ft.)
swim
POOL
0 YES (3 NO
PLAN CHECKED BY
REMARKS
ZUMBER OF STORIES
NUMBIUlt UP
DWELLING
UNITS
�TATURE OF WORK TO BE DONE
Demolish
Plan Check No .............
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
FENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this Application; that the In-
formation given to correct; anti that I sm the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorized thereby, no person
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
3IGNATURE (OWNER OR AGENT)
DATE SIGNED
NOTE: Applicant Subject to Plats Check Fee
Pa 6-1107
This remit coven work to ba done on private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
ntarquees. etc.) will require separate pern-doolon.
[] YES 0 NO
Valuation
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-
Imowledged in space provided.
r—CA- _1�
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