680463.pdfBUILDING DEPARTMEN
PERMIT APPLICATION
1 NAME (OR NAME OF BUSINESS)
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Legal Description of Property (Sli
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Applicant Fill
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CITY LICENSE NUFd
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or Attach Four copies
NEW
ADD
ALTER
REPAIR
RESIDENTIAL
NON-RESIDENTIAL
F-1
GAS
LINE
SIGN
RETAINING
WALL
PENCE
( .......... x .......... Ft.)
swim
POOL
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1101 DEMOLISH
MCCAVATE
M OR FILL
0 PRE -MOVE
INSP.
;UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
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DN FROLL MAP NO.:
PERMIT
I NUMBER 68046-3
C3 YES C3 NO
E3aSTING-STREET R/W ........... YT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... 1". ........ ... 1;T.
OF
13 YES [3 NO
Plan Check No . ......
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
IMCCAVATION OR FILL
TOTAL AMOUNT DUE
0 YES [3 NO
Fee
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No.
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I hereby acknowledge that I have read this application; that the in-
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a u or
formation given to correct; and that I am the owner, or the duly author-
w a -
ized agent of the owner. I agree to comply with city and state laws regu-
re "n
ATTENZ[ON
APPLICATION APPROVAL
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lating construction; and In doing the work authorized thereby, no person
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wHI be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
wm_
be com-
shall be completed in ninety days; MOVED -IN BUILDINGS ahallrj
Imowledged in space provided.
plated In nix months.)
SIGNATURE (OWNER OR AGENT) DATE BIG Z13
INSPECTION
DEPARTMENT
DIRE CRIS SIGNATURE
Z7
CITY OF
EDMONDS
NOTE: Applicant Subj vct to Plan Cbeck Fee
PR 6-1107
This Pegmit covers Work to be done an private PrOPutY ONLY -
Any construction on the public dornala (curbso sidaynalkso drivewayst
FILE
nlwquws, etc.) will require 56PArSte permission -
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