680098.pdfBUILDING DEPARTMENT Applicant Fill.
PERMIT APPLICATIO14 I Inside Heavy Unes
I
I—. cLs-
I 1� IV
RESIDENTIAL
F�
NEW
N
NON-RESID ENTIAL
DEMOLISH
DALTER
EXCAVATE
OR FILL
REPAIR
PRE -MOVE
INSP.
DWELLING
UNITS .1
S'r, (0 (
GAS
LINE
SIGN
RETAINING
WALL
PENCE
( ........ x ........ Ft.)
swim
POOL
EXISTING STREET R/W ....... XT.
COUP. PLAN ST. R/W ....... ... XT.
0 YES
13 NO
Plan Check No ................. ...
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I EXCAVATION OR FILL
AL A MOUNT I
TOTAL AMOUNT DUE
lh� In -
I hereby acknowledge that I have read this application; that the in-
aU or
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.
'a ro
M
ATTENTION
AT NTIO"
per n
lating construction; and In doing the work authorized thereby, no person
lolit
will be employed In violation of the Labor Code of the State of Washington
T U ERB I
I a P
THIS PERMIT
relating to Workmen's Compensation Insurance.
tj
AUTHORIZES
1
NOTE: Permit Limit One Your (Except DEMOLITIONS which
f
ONLY THE
? HE
1]
WORK NOTZD
shall be Completed in ninety MOVEDAN BUILDINGS shall be com-
pleted In six months.) r)
AT (O:VNE] OR A E T) DATE SIGN-ED
8 CTIO
INSPECTION
3,
;Z:-12A�
DEPARTMENT
M
CITY OF
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
This Permit coven work to be done on Private PfOpeAy ONLY.
Any construction on the pubtle domain (earbl, sidewalks, driveways,
marquees, etc.) will "Qutre Napo%to permission.
PERMIT
NUMBER
680098
13 YES
El NO
DEFICIENCY THIS PROPERTY
13 YES
Fee
13 NO
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.
D 3 BIGNATUM
)DATE