680400.pdfI 0�
BUILDING DEPARTMENT
UIL DIN
P Mi!
ERMIT APPLICATION
7
N LE
AME (OR NAME OF BUSINESS)
G AD
MAILING ADDRESS
CI
wici
Z
ADDRESS
CITY
NAME
ADDRESS
Applicant Fill
inside Heavy Lines
Cj —
TELEPHONE NUMBER
7:lzd-25�oP�L-
CITY LICENSE NUMBER
or Attach Four Copies)
NEW
TErRESIDENTLILL
GAS
LINE
ADD
LENON-RESIDENTIJILL
I—
SIGN
RETAINING
MDEMOLISH
FIWALL
ALTER
M
EXCAVATE
OR FILL
El
PENCE
( x Ft.)
REPAIR
1:1
PRE -MOVE
INSP.
........ . ..........
swim
POOL
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
MXURE OF WqRK TO BE DONE
2) Izzc ') - e e, t - .3
/X,,-)
- :7-7
6, -�'r -P glae_
A9 6-c5_7
EN38TING STREET
COMP. PLAN ST. R/W .. ......... FT.
[] YES 13 NO
Plan Check No ............ . ....
BUILDING
PLUMBING
HEAT & GAS LINE
t
PENCE
SIGN C4:*
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 owner. or the duly author-
Ized agent of the owner. I agree 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 Coda of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS ahall be coca.
plated In six months.)
0 DATEI SIGNED
TURE(OWNER re G V
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs$ sidewalks, driverwaysp
mantioes, ate.) will require separate perrrAsslon.
AT17ENTION
THIS PERBUT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
PERMIT
NUMBER 680400
- -4 0
VACANT SITE
0 YES (3 NO
vARIj4LNCE NUMBER pm
DEFICIENCY TH113 PROPERTY
I
0 YES M NO
Fee I Receipt No.
. 057 0 1 W/. a 0
WMA/y
101"Bu r. R
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-
Imowledged in space provided.
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