690042.pdfI
124
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BUILDING DEPARTMEN
PERMIT APPLICATION
NAME (OR NAXM OF BUSINESS)
IZA 14 ,n
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7 T Applicant Fin
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Ins:1de Heavy Une JOIS AD
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NEW
RESIDENTIAL
El
GAS
LINE
NON-RMDENTLILL
SIGN
ADD
RETAINING
WALL
JALTER
DEMOLISH
EXCAVATE
FVNCE
OR rim
REPAIR
PRE -MOVE
INSP.
swim
POOL
DWELLING
UNITS
I hereby acknowledge that I have read this application; Mat 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 law# 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 Workman's Compensation Insurance.
NOTE: Permit Limit One Your (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILOINGS shall be com.
plated In six months.)
NOTE: Applicitnt Subject to Plan Check Fee
-jids Permit coven work to be done an private property ONLY.
A" eeneftuction on the public domain (curbs, sidewalks, driveways,
mwquws, aft.) will require separate*permisslon.
5
OLL MAP No.:
FZRMIT
690042
KUMIBER
,TDACK
OTHISKA' BET33ACK
I aMAR YARD BET13ACK
J,0 tAll
LOT AREA
VACANT OrrE
13 YES ZNO
I Ur"T _"Mn Al
EXISTING STREET R/W
COMP. PLAN ST. R/W .... ...... XT-
[] YES 13 NO
Plan Check No ........
BUILI)ING
PLUMBING
HEAT & GAS LIM
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
TIM PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
My OF
EDMONDS
PE 6-1107
DEFICIENCY THIS PROPERTY
0 C)
13 YES
Fee
!ice
No.
Folms 17M
APPLICATION APPROVAL
This application is not a permit until
oigned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in Space provided.
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