690000.pdffl
V
BUILDING DEPARTMENT
PERMIT APPLICATION
01
W
Applicant Fill
Inside Heavy Lines
NEW
RESIDENTIAI,
J
GAS
LINE
NON-RESIDENTIAI,
F_J
SIGN
0 ADD
RETAnqiNa
DEMOT-TSH
WALL
ALTER
EXCAVATE
OR FILL
PENCE
Ft.)
REPAIR
PRE -MOVE
INSP.
........
amm
POOL
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 WaahtDgtOn
relating to Workman's Compensation Insurance.
NOTE: Permit Limit One Your (Except DEMOLITIONS which
shall be completed In ninety days; MOVED�IN BUILDINGS shall be oom-
plated In six months.)
Ild vov 6U,14,
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done an private property ONLY.
Any construction on the public domain (curb@, oldowalkso drivewayst
marquess, ate.) win require separate perrniesion.
P No�f PERMIT
I NUMBER 690000
� 3 1 hda � 1,/� za � �
BACK BTUEETr SETBACK AR YARD BE
I RE
;L0 t�j �s A�
17 LOT AREA VAUJ"W bl'
1 0 YES 1<
EXISTING STREET R/W .......... FT.
COUP. PLAN ST. R/W ........ ... VT.
[] YES
Plan Check No...
BUILDING
PLUMSWG
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
OLrrION
PRE -MOVE INSPECTION
MCCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THISPERMT
AUTHORIZES
ONLY TEM
WonK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
MA
D2MCIENCY TMS PROPERTY
I -
[3 YES 13 NO
I & , aic W i ct 1.'
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.
d 11,
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