680290.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAM
WAILING ADDRESS
-7 -7
CITY
0
NAME
M
ADDRINad
CITY
NAME
ADDRESS
STATE LICENSE
-1.2423 a i
I Legal Description
NEW
ADD
ALTER
E] REPAIR
0 N
Applicant Fill
Inside'lileavy Lines
FIR c, - T"I /,,
.3-141-999
Cl
Below or All
% A-r LIJ
RESIDENTIAL
GAS
4E
LIN
NON-RESIDENTLtL
SIGI;
�TAn-TXNG
WALL
DEMOT-19
EXCAVATE
OR FILL
FENCE
(.--...-x ..... . ... Ft.)
PRE -MOVE
rNSP.
swim
POOL
DWELLING
UNITS
12
(>2
1 hereby acknowledge that I have road U315 application; that ties In-
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 xvgu-
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
relating to Workman's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED-11N BUILDINGS shall be core.
plated Ip six months.)
51 W02W11FAN 0�2MINWA &-Z
J NOTE: Applicant Sub)ect to Plats Check Fee
_jh_j& Permit covers work to be done on private property ONLY.
Any oonstrncttoti�* the public domain (curbs, sidewalks. drlv6w&Yo,
plarqump, ate.) will require separate permission.
i
I
P NO.: PERMIT
*rc-/ / I NUMBER
BEAR
BEAR
STRFJCT SETBACK
..� I N
5 rn I h
EXISTING STREET R/WJG0..FT-
COMP. PLAN ST. R/W.1�20_FT-
Driveway slo
indicated on
I I
El YES [3 NO
Plan Check No...
I
BUILDING
PLUMBING
VEAT & GAS LINE
FENCE
SIGN
112TAINING WALL J,
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR r7LL
TOTAL AMOUNT DUE
ATTENTION
Tins PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
N
E] YES (3 NO
Elk VAJUANUM NUMBER
DMIFICIENCY THIS
not to exceed
ndard Drawing
6"
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-
lmowledged in space provided.
D70 a BIG A R�n
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