680546.pdf7—
POSTED ON KROLL MAP NO.:
PERMIT
NUMBER
680546
BUILDIN DEPARTMENT
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B U I L DI N(
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Applicant Fill
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PERMIT APPLICATION
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NAME ( R NAME ur BUSINESS)
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0 YES [3 NO
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BUILDING AREA
VAItIA"UM4 NUMBER
NAME
PLOT PLAN Al�;�OVE
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ADDRESS
jGrSTnEET R/W ............ FT.
DEFICIENCY THIS PROPERTY
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CITY
TELEPHONE NUM13ER
OL PHONE
COMP. PLAN ST. R/W ............ FT.
........ ... Fr.
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0 C-3 T-_>
ElNEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
SIGN
ADD
RETAINING
WALL
DEMOLISH
E] ALTER
EXCAVATE
OR FILL
VENCE
( .......... x .......... Ft.)
REPAIR
PRE -MOVE
INSP.
EIPOOL
SWIM
NUMBER 0
DWELLING
UNITS
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I hereby acknowledge that I have read thin application; that the In-
formation given in correct; and that I am the owner, or the duly author-
lzed 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 Workmen's Compensation Insurance.
NOTE: Permit Umit One Yetir (Except DE51011TIONS which
shall be completed in ninety days; MGVED-IN BUILDINGS shall be com.
ploted in six months.)
N04. Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (ourbal oldewalkso driveways#
numquees, etc.) will require separate permission.
FIRE
[j YES [3 No
(3 YES [3 NO
Sign to be relocated in the event Of
sale of clinic site. 12—a6-68 AE
Plan Check No ............. .. ....
BUILDING
PLUMBING
HEAT & GAS LINE
0 0 /0, 12 Q
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
56 1�
P4
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No.
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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