680507.pdf7
BUILDING DMMMENT
PERMIT APPLICATION
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Applicalat Fill
Inside Heavy Lines
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lion of Property (Show Below or AM=
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NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAI,
SIGN
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
on FILL
FENCE
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REPAIR
PRE -MOVE
INSP.
El
swim
POOL
FE-87-1
NUMBER OF
DWELLING
UNITS
NATURE OF WO!5F_TO BE DONE
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P NO.: PERMIT
I NUMBER
680507
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BUILDING ARNA
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NO
Q _4?T G'STR
N EET R/W..IJQ.FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. n/w .4-.0 .. FT.
indicated on Standard Drawing #103.
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[3 YES
for running storm drainage into alley.
Plan Check No ............. ......
IED USE
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BUILDING
PLUMBING
-LAN (Indicate
Building streets)
KV (0
IJEAT & GAS LINE
PENCE
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 Is 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-
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 Yetir (Except DE51013TIONS which
shall be completed in ninety days; MOVED-JIN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
Thin Permit coven work to be done on private property ONLY.
Any construction On the public domain (curb%# shiewalkst driveways,
marquees, etc.) will require separate Pem)[261041-
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
Valuation
all "
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.
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