670589.pdf5, DEPARTMENT
"APPLICATION
Applicant 011
Liside Heavy Lines
D - 5th Avenue North
TELEPHONE NUMB
p9nds Wn. Pr. 6-1107
im, F"",
'V�77�1
NEW
RESIDENTIA
0
GAS
LINE
NON -RESIDE TIAL
SIGN
RETAINING
DEMOLISH
EIWALL
ALTER
EXCAVATE
OR FILL
FENCE
( x Ft.)
........ . ..........
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
ES
NUMBER OF
DWELLING
UNITS
Demolish
I hereby acknowledge that I hftV6 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-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Wamhlngton
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE51011TIONS which
shall be completed in ninety days; BIOVED-IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on Private Property ONLY.
Any construction on Lhe public domain (curbs, sidewalks, driveways,
Marquees, ate.) will require separate permission.
.... .......
20328 - 83rdWest
EXISTING STREET R/W .......... FT -
COUP. PLAN ST. R/W ........... XT-
[] YES
[3 NO
Plan Check No ........
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE IN13PECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
PERMIT
NUMBER 670589
13 YES NO
DEFICIENCY THIS PROPERTY
[3 YES E] NO
Valuation
APPLICATION APPROVAL
ow
I
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.
I.
FILE
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