680072.pdfAppUcant T111
Inside Heavy Lines
RM
NEW
RESIDENTIAL
I
U2
GAS
LINE
NTIJILL
El
SIGN
ADD
RETAINING
ElDEMOLISH
WALL
ALTER
f--j
EXCAVATE
OR FILL
FENCE
(---x Ft.)
. . .......
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
t
I hereby scitnowledge that I have read this application; that the In-
formation given is correct; and that I = the owner, or the duly author-
ized agent of the owner. I &me to comply with city and state laws regu-
Isting construction; and In doing the work authorized thereby. no person
will be employed in violation of the Labor Code of the State of Washington
rsIlLting to Workmens Compensation Ibfiur&bc6-
NOTE: Permit Limit One Year (Except DmlolmoNs which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.) A
j_Ay0_R_E(OW11ER,O A DATE SIGNED
NOTE: Applicant Subject to Plan Cbeck Fee
This Pennit covers work to be done on private propenY uv�r-
Any construction an the public domain (curbs, sidewalks, driveways,
cusnuem ate.) will require separate permission.
EN38TING STREET R/W
COMP. PLAN ST. R/W ------- XT-
[] YES [3 NO
Plan Check No ........
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAIMNG WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TIM
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 11-1107
PERMIT
NUMBER
680072
L P-04 E
0 YE13
NO
DEFICIENCY TMS PROPERTY
13 YES 13 NO
Fee
NO.
APPLICATION APPROVAL
This application is not a permit unT
signed by the Building Official or Ids Dep-
Uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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