680414.pdfa
UILDING DEPARTMENT Applicant M
PERMIT APPLICATION Inside Heavy Lines
4AMIC (OR MAMA OF BUSINESS)
KXFAtLG ADDRESS
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UCENSM NUMBER CITY LICEI
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incription of Property (Show Below or Attach PC
RESIDENTIAL
GAS
LINE
S4 NEW
NON-RESIDENTIAL
SIGN
RETAINING
DEMOLISH
WALL
ALTER
Q
EXCAVATE
OR FILL
PENCE
( x Ft.)
REPAIR
1:1
PRE -MOVE
INSP.
......... . ........
SWIM
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
OSTED ON KROLL 39AP NOA PERMIT
NUMBER
)B ADDRESS
13 Bog
ME YARD BEFISACK I BTRICET SET
/ 00)7
5_11 /17 dIVII-01 .20
I.T 1 00,6:,00, 0
VACANT Br —
rE
C3
VA YES C3 NO
E=STIN� STREET R/w .6-Civ. DEvicimor Tms PROPERTY
COUP. PLAN ST. R1W.1ra.O.FT. ..C) ..... 3".
q 1 13/,j i I -
[I YE13 V040
A
Plan Check No ..................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR PILL
TOTAL "OUNT DUE
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-
lzed agent of the owner, I agree to comply with city and state laws regu-
ATTENT]ION
luting 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
NOTE: Permit Limi t one Your (Except DEMOLUIONS which
ONLY THE
WORK NOTED
e;&`I`beloted in ninety days; MOVED-XN BUILDINGS shall be oom-
pleted In six 0
DATE SIGNED
INSPECTION
DEPARTMENT
CIMY OF
\j
EDMONDS
NOTE: Appli"nt Subject to Plan Cbeck Fee
PR 6.1107
This Permit coven work to be done an private Property ONLY.
Any nonstruction an the public donvaln (curbs, sidewalkst drIvewayst
marquees, ate.) will require separate permission.
W
13 YES 13 NO
Valuation Fee
V / *. 5- o 1 fx�6 ' 4
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.
DATE
rum