680191.pdf............
FBBUILDING DEPARTMENT
PERMIT APPLICATION
N I
AME (OR NAMIS OF.UUSINESS)
Z
Applicant Fill
inside Heavy Lines
or
RESIDENTIAL
GAS
LINE
ElNEW
NON-nESIDENTIAL
SIGN
ADD
F1
RETAINING
WALL
DEMOLISH
ALTER EXCAVATE
OR FILL
FENCE
( x Ft.)
........ . .........
REPAIR PRE -MOVE
INSP.
SWIM
POOL
NUMBER or
DW'ELJ.JNG
UNITS
<Z� �<�
Ir PERMIT
NUMBER
680191
J
[3 YES 13 NO
EXISTING -STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ IT- ........ ... 1�`T.
[] YES 0 NO
REMARKS
Plan Check No ............
BUILDING
PLUBV31NG
HEAT & GAS LINE
FENCE
t 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 in-
formation given in correct: and that I am the oivner. or the duly author-
ized agent of the owner. I agree to comply with city and state lawn regu- ATTENTION
latIng construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the Slats Of Washington THIS PERMIT
relating to WorkmeWn Compensation Insurance, AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan
SIGNED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Fee
PR 6-1107
This Permit coven work to be done Out private property ux4bx-
Any construction on the public domain (curbs, sidewalks, drIverwayn,
nuirquees, etc.) will require separate permission.
'000"
Valuation
&0
13 YES [3 NO
Fee
No.
1 -5-. 00 &0 1
APPLICATION APPROVAL
This application is not a perinit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
d- $ ,
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