680016.pdfON KROLL MAP NO.:
N POSTED PERMIT
BUILDING DEPARTMENT �11 A: I NUMBER 680016
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PERMIT APPLICATION - I - g AL
NAME (OR NAMIG OF BUSLNESB) 1 *7 OL'o
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CITY
IRTATE -LICENSE NUMBER
Legal Description of Property (Show
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0 YES
NO
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EXISTING STREET R/W .......... FT. DEFICIENCY TE38 PROPERTY
COUP. PLAN ST. R/W ........... .......... 1". 0
REMARKS IA
IREMARKS
w or Attach Four Copies)
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TYPE CONNECTION VERIFIED BY
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PERO. TEST PERMIT NUMBER
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LINE
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PLAN CHECKED BY
NON-RESIDENTIAL SIGN
IYADD REDIT
W IfNING
DEMOLISH
ALTER EXCAVATE FENCE
1:1 OR FILL X Ft.)
1101.
... ..... ..........
REPAIR PRE -MOVE swim
INSP. POOL
ES NUMBER OF
DWELLING
t UNITS
NATURE OF WORK TO BE DONE;
Valuation Fee Receipt No.
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Plan Check No ..................
PROPOSED UBE
BUILDING
na _&L
9LEUT PLAN (Indicate Building setbacks. abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
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SIGN
N
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 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-
ATTEr-MON
APPLICATION APPROVAL
lating constructl0n; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code Of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS whIch
ONLY TIIE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
kmowlLdged in space provided.
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
DLFLEC OR'S SIGNATJ�
CITY OF
EDMONDS
DATIr
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate pennisslon.
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