680162.pdfPOSTED ON KROLL MJALP NO-:
�I,QILDING DEPARTMENT Applicant FIR
IT APPLICATION Inside Heavy Lnes ioD ADDRESS
OR NAME
OF DUST 8)
BIDE YARD 8 ACK STREET I
ADDRESS 0
'7 USMONE LAM ARE
ILA
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4-r4��
410
C_
ElNEW
aRESIDENTIAL
GAS
LINE
M�AIOD
NON-R
[= ESIDENTLALL
SIGN
RETAINING
DEMOLISH
WALL
aALTER
EXCAVATE
OR rim
PENCE
( x Ft.)
......... . .......
REPAIR
0
PRE -MOVE
INSP.
swim
POOL
NUMBER OF
DWELLING
6�7-'E_
UNITS
MrUREOV�_WORK TO 13E DONE
'/_Z/ , e'.
1 ).0 47;?X-.EW.;e
PERMIT
NUMBER 680162
pr
I I
AM SM
13 YES 0 NO
____ —1 _'
E313STING STREET R/W ......... YT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... FT. # ....... ... 1".
[] YES [3 NO
Plan Chock No ............
BUILDING
PLUMBING
HEAT a GAS LINE
PENCE
SIGN
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 to -
formation given In 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-
ATTFaMON
laUng construction; and In doing the work authorized thereby, no Damn
will be employed In violation Of the Labor Code of the State of Washington
THIS PERMIT
rsl"Wg to WorkmeWs COMPOMALUOU, Insurance-
AUTHORIZES
NOTE: permit Umit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed to ninety days; MOVED -IN BUUMIENGS shall be OOm-
plated In NLZ mOuths-)
FA—T—URE(OWNER OR AGENT) DATE ONE INSPECTION
DEPARTMENT
17� CITY OF
EDMONDS
NOT,& Applicant Subject to Plan Check Fee PR 6.1107
This p WA& cov s work to be done an private property ONLY.
Any con"eactlon an &be public donsain (curbso sidewalkst drivewayap
roviquees, ate.) will require separate permission.
13 YES 0 NO
Fee
AIR
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.
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yLLIR