680540.pdfBUILDING DEPARTMENT Applicant FM
Inside Heavy Lines
,-PERMIT APPLICATION
NA3M, (OR NAME OF BUSINESS)
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RESIDEN
0
GAS
LINE
NEW
NON-RES NTIAL
SIGN
ADD
RETAINING
WALL
DEMOU
ALTER EXCAVATE
on FILT
IV
low
PENCE
( x Ft.)
........ . .........
REPAIR PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF STORIES
NUE—MER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
On As C 11t6-T*AE �FE- T/,&j ty I ilk cr
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ULP NO
W
Fid
EXISTING STREET R/W .......... FT.
COMP. PLAN ST. R/W ........ .. 1Pr-
TYPE
[3 YES 13 NO
PERMIT
NUMBER 680540
NO
NE—H
lim CIENCY THIS PROPERTY
13 YES [3 No
Retaining wall will be on the s w corner
and on the property line,
Plan Check No ..................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
N
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 regui-
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
THIS PERMIT
relating to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN ILDINGS shall be com-
17
pleted in Oil mO,4
NT) DATE 91ONELj3
INSPECTION
DEPARTMENT
7ol&
CITY OF
EDMONDS
OTE: Applicant Subject to Man Check Fee
PR 6-1107
This Pervalt coven work to be done on prIvUe property ONLY.
Any construction on the pubtle docosin (curbs, sidawalks, driveways,
me noes, etc.) will require separate perniAsslon.
valuation I Fee
20
Oo 0 6
No.
APPLICATION APPROVAL
This application is not a permit until
Signed by the Building Official or Ws Dep-
uty; and f sea are paid, and receipt is ac-
knowledged in space provided.
DIRECTO 'S ONA!7
DATXI'�
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