680446.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
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Applicant Fill
Inside Heavy Lines
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DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
INSP.
El
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( ........ . x .......... Ft.)
swim
POOL
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PLAN
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DWELLING
UNITS
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11 KROLL MAP NO.:
PERMIT
NUMBER
680446
WEI
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1) SETBACK
STREET SETBACK
RNAR YARD SETS
I
YES
STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
Plan Check No ................. .
BUILDING
ate Billding setbacks, abutting streets)
t
N
PLUMBING
HEAT & GAS LINE
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
TIMIS PERMIT
I
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com-
pleted In six months.)
1IONATURE (OWNER OR T) DATE 8 NED.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicad Subject to Plan Cbeck Fec
PR 0-1107
This Pennit coven work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will "Quire separate permission.
Valuation
00
[I YES [3 No
Fee
M
No.
1 67. 0 0 1 (416 -7 0'
APPLICATION APPROVAL
This application Is not a permit until
signed by tile Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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