680368.pdfPOSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT I NUM13ER 6803168
ION Applicant F -p- L9
Inside Heavy Lines JOB ADDRESS
PERMIT APPLICAT
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I LOT AREA VACANT SITE
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NO STREET R/W jfij.(j.FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ..G.O.XT. ... ITT.
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indicated on Standard Drawing #103.
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SIDENTIAL
NON-RESIDENTIAL
DEMOLISH
EXCAVATE
DOR FULL
REPAIR PRE -MOVE
11 INSP.
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SIGN
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POOL
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PLAN
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RUMBER OF 13TORIES
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NATURE OF WORK TO BE DONE
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Plan Check No .....................
PROPOSED USE BUILDING
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—PLOT PLAN (Indicate Building setbacks, abutting streets) PLUMBING
0 HEAT & GAS LINE
FENCE
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RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In-
format.lon 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 Workman's Compensation Insurance. AUTHORIZES
ONLY TIM
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shalt be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.) INSPECTION
SL%JLk4ATUr.n; tu%yllE OR AGE T) DATE SIGNED DEPARTMENT
7 "'.' I 'g — � — 6 4
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Permit covers work to be done an private property ONLY.
Amy construction an the public domain (curbs, sidewalks, driveways,
marquees, ate.) will require separate Permission.
BY
Valuation
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Fee
APPLICATION APPROVAL
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No.
This application is not a permit until
Signed by Uie Building official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in Space provided.
FILE
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Date Passed
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