680471.pdf— f.1
BUILDING
POSTED
DEPARTMENT
Applicant n1l
4�4
PERMIT
APPLICATION Inside Heavy Unes JOB ADD
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6 MAP NO.: 680471
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EXISTING STREET R/W ........... FT.
COMP. PLAN ST. R/W ........ ... FT.
0 YES E3 NO
DEFICIENCY THIS PROPERTY
....... .... FT.
01
TYPE CONNECTION VERIFIED BY
PERO. TEST PERMIT NUMBER
ki REMARKS
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FIR111 ZONE TYPE OF CONSTRUCTION STREET IMPROVED I I t �?
E] NEW
RESIDENTIAL
El
GAS
LINE
11
r,
NON-REWDENTIAL
ADD
SIGN
RDEMOLISH
RETAINING
WALL
EXCAVATE
PENCE
ALTER
11
OR PILL
(
PRE -MOVE
......... x .......... Ft.)
SWIM
REPAIR
INSP.
POOL
DWELLING
UNITS
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I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duly author.
fted 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 WorkmeWs Compensation Insurance.
NOTE: Permit Limit One Your (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be oom.
pleted In six months.)
5IGNATURE (OWNER OR AGENT) DATE SIGNEI)t
F—g L9
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done = private property ONLY.
Any construction on the pubtle domain (cubs, sidewalks, driveways,
marquees, ate.) will require separate permission.
[] YES
13 NO
Plan Check No ........
BLTILJ31NG
PLUMBING
BEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR PILL
TOTAL AMOUNT DUE
ATIFOPrION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
[] YES 13 NO
Valuation I Fee
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or Ids Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
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