680407.pdf4
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BUILDING DEPARTMENT
PE RMIT APPLICA ION I
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CITY
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POSTED ON KROLL MAP NO.; PERIM
Applicant Fm NUMBER 680407
Inside Heavy Lines JOB ADD�Pll
TELEPHONE NUMBEs
P D, 1? -5111 S q_
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D nnsiD ENTIAL
GAS
LINE
NON-RIMIDENTIAL
SIGN
DEMOIJSH
RETAINING
WALL
MCCAVATE
PENCE
OR PILL
Ft.)
EPRE
-MOVE
INSP.
swim
POOL
DWELLING
UNITS
QC�111
e 1 10
19
I hereby acknowledge that I have read this appllc&tjon; that the In.
formation 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.
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 Your (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be nom.
pleted In six months.)
168
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any oonstructlan an the public domain (curbs, sldaw&W, driveways,
me uses, etc.) will require separate permission.
5.10
WaSTING STREET
COUP. PLAN ST. R/W ......... .7r.
[] YES
11=0
Plan Cbeck No ........
BUILDING C
HEAT & GAS LINE
PENCE
SIGN
RETAJNING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR PILL
TOTAL iMOUNT DUE
AT=14MON
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
CITY OF
EDMONDS
PH 6-1167
[SRI �.Nla*j
DEFICIENCY THIS PROPERTY
Valuation
13 YES E3 NO
Fee
I -A , 0-o I (#P (P47
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.
; twF 00
DATE
FILE