690044.pdf-POSTED ON KROLL
BUILDING DEPARTMENT Applicant Fill
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Inside Heavy Lines _JOB ADDRESS
PERMIT APPLICATION :71
NAME (OR NAME OF BUSINESS)
SIDE
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RESIDENTIAL
A"E
�IN
NEW
19
R
NON-nESIDENTIAL
a I Oiq
nDEMOLISH
-
RETAINING
WALL
EXCAVATE
PENCE
ALTER
n
OR FILL
( ........ . X .......... Ft.)
REPAIR
n
PRE -MOVE
INSP.
E]
swim
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
I hereby acknowledge that I have read this application; that the In-
formation given In 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 rogu-
iatlug 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 Limit One Year (Except DE51OLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers %vork to be clone on private property ONLY.
AnY construction on the public domain (curbs, sidewalks, driveways,
a1ze,lueell, etc.) will require separate Permission.
OT a,
E I
EXISTING STREET R/W ............ FT -
COMP. PLAN ST. R/W ........... XT.
rl YES
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WAT-1,
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
ArMNTION
THIS PERBUT
AUTHORIZES
ONLY TIM
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
rn 6-1107
PERMIT
NUMBER
�' W.
L-f I /7)'"_'j . 0
VACANT SITE
YES 0
)9:9-4
VARIANCE NUMBER N
DEFICIENCY THIS PROPERTY
Z
STREET
0 YES
Fee I Receipt No.
00
6.0-6]
..........
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or Itis Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
I I
FILE