680122.pdfI
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BUILDING DEPARTMEN
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
7 _A
,!;r e�
Applicant Fill
Inside Heavy Lines
P/? j>- qj
or
EX36TING STREET R/W ---FT-
coup. PLAN ST. n/w ........ ... FT.
0 NEW
ADD
ALTER
REPAIR
RESIDENTIAL
1 1:1 NON-RMDENTIAL
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
F1 INSP.
Li
Ej
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( ........ . x .......... Ft.)
SWIM
POOL
13 YES 13 NO
PLAN CHNUILED BY
REMARKS
I
CS
NUMBER OF
DWELIaNG
UNITS
Z *:�.* - -
;� .. A%A.1tP I/K"
Plan Chock NO ......... ..........
PROPOS USE �j
BUILDING
PLOT PLAN (Indt Bu9ding setbacks, abutting streets)
PLUMBING
BEAT & GAS LINE
FENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
OLITION
PRE.MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In-
formation given to 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.
ATTENTION
latIng construction; 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
relating to workmews Compensation Insurance.
AUTHORXZES
ONLY THE
NOTE: Permit Limit One Your (Except DEMOLITIONS which
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
plated In six months.)
(OWNER OR AGEV AT SIGNED
INSPECTION
DEPARTMENT
1 3/24 6
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At9A AZ* IrY3
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Cbeck Fee
PIL 6-1147
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driverways,
marquees, etc.) will require separate permission.
'ERMIT
i UMBER
13 YES 0 NO
DEFICIENCY THIS PROPERTY
13 YES 0 NO
Valuation I Fee
No.
I :� SO?) I '*j"'i
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_
FILE
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