680409.pdfUILDING DEPARTMENT
PERMIT APPLICATION
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POSTED ON KROLL MAP NO-: PERMIT
I NUMBER 680409
JOB ADDRESS Cy-
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BIDE YARD BET13ACIL in7nE=8ETBACK REAR YARD 017rl"
I a I 11:1 YES
WaSTING I STREET R/W ............ Fr- DEFICIENCY THI13 PROPERTY
COMP. PLAN ST. R/W ............ FT- ....
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indicated on Standard Drawing #103.
Plan Check No....
BUILDING
PLUMBING
HEAT & GAS LINE
t
FENCE
SIGN
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-
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 Workmens Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In mix months.)
INSPECTION
DEPARTMENT
]IONATURE (OWNER Oil AGENT) DATE SIGNED
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Chech. Fee
PH 6-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquess, ete.) will require separate permission -
— AJ 113 YES C3 NO
Valuation I Fee i Receipt No.
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APPLICATION APPROVAL L
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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RECORD OF. INSPECTIONS,
Date.Passed
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