680292.pdf4.
POSTEII:
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PERMIT APPLICATIO14 inside Heavy Lines
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NAM (OR NAMID OF BUSINESS)
Z ;/A A1 f) I A R1, P t--
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or
I
RESIDENTIAL
GAS
LINE,
ElNEW
R
NON-RESIDENTIAL
SIGN
UAD"
RETAINING
F1DEMOLISH
WALL
ElALTER
F1
EXCAVATE
OR FILL
FENCE
( ........ . x .......... Ft.)
REPAIR
n
PRE -MOVE
INSP.
swim
POOL
TS—�--INUMBER
OF
DWELLING
UNITS
'nod a
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i
I hereby acknowledge that I have read this application; that the In.
formation given Is correct; and that I am the owner, or the duly author-
ized agent of the owner. I ease to comply with city and state laws regu.
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
relating to Workman's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
pletcd in six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to he done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
PERMIT
NUMBER 680292
TAJ ty)
REA" kWRD_ SETI
'BACK STREET UNTISACK,
EXISTING STREET R/W ........... IrT-
COMP. PLAN ST. R/W ........... AFT.
0 YES
TYPE OF
11111M,
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
OLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORIK NOTED
INSPECT10N
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
- 1 [3 YES
DEFICIENCY THIS PROPERTY
STFtE T IMPROVI
[] YES [:] ITO
Valuation I Fee
VS 1 Xc�c, 0 a
r
I
Receipt No.
13 5, 0 o I k(s-o �;-
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.