680101.pdfPOSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fill 680101
Inside Heavy Lines JOB ADDRESS
PERMIT APPLICATION
NAME (OA NAME OF BUSINESS) S7 t) -4 - -:1 A 61 Ili
MAILING ADDRESS
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CITY TEWPHONE NUMBER
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ption of Property (sh-Low Below o;
aNEW
RESIDENTIAL
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ElADD
NON-RESIDENTIAL
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SIGN
RETAINING
El
WALL
DEMOLISH
EXCAVATE
FENCE
ALTER
OR FILL
( x 111.)
REPAIR
PRE -MOVE
INSP.
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swim
POOL
DWELLING
UNITS
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PROPOSED USE
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PLOT PLAN (Indicate Building setbacks, abutting streets)
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I hereby acknowledge that I have read thin application; that the in-
formation given Is correct; and that I am the owner, or the duly autuw-
Ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; mud in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com-
pleted In nix months.)
NOTE: Applicant Subject to Plan Chech, Fce
Thin Permit coven work to be done an private property ONLY.
Any construction an the public domain (ourbs. Sidewalks, driveways,
marquees, etc.) win require separate permleston.
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EMSTING STREET n/W
COUP. PLAN ST. R/W
,257 1 /b �J. / -s-, /)7 Li
T AREA vAuAriw HITE
1 E3 YES C3_�o
MLDING AREA I VARIANCE NUMBEI
4.0.jrr. DEFICIENCY THIS PROPERTY
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13 YES [3 NO
C] YES [3 NO
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Valuation
Fee
Receipt No.
Plan Check No ................ ...
BUILDING
00
AAB
PLUMBING
/5,
HEAT & GAS LINE
41
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PnE-MOVE INSPECTION
MCCAVATION OR FILL
TOTAL AMOUNT DUE
004 00
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZFS
signed by the Building Official or We Dep-
DNLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
linowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pn 6-1107
DATE
FILE
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