690251.pdfPOSTED ON KROLL MAP NO.: PERMIT
NUMBER
BUILDING DEPARTMENT AppUcant F1U
Inside Heavy Lines iOS ADDRESS
PERMIT APPLICATION 01
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,egal Description of Property (Show Below or Attach Four Copies)
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690251
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BUILDI UM—B E R
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PLOT �PPMP
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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-
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 Washington
relating to Workman's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be Completed in ninety days; MOVED-XN BUILDINGS shall be com-
pleted in six months.)
M. MIKIMAQW,
NOTE: APp�cant Subject to Plan Check Fee
_ihis —Permit covers work to be done on private Property ONJUX-
Amy construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission-
IS �I2 STREET RIW .......... FT. DEFICIENCY THIS PROPERTY
:OMP, PLAN ST. R/W ............ FT- ........... 3".
MARKS
IIECKED BY
�T= SIZE SERVICE SIZE CLEARANCE
CHECKED BY
I
rYPE CONNECTION
VERIFIED BY
FERC. �TFSr
PERMIT NUMBER
V
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
Z [:] YES
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
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PLAN CkIZUKED "X
REMARKW
Fee
Plan Check No .....................
BUILDING
FLUM33ING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
No.
TOTAL AMOUNT DUE
MOUNT
ATI!ENTION APPLICATION APPROVAL
I(
T TMS PERMIT This application is not a permit until
S7
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rAUTHORIZES
THO
ON Signed by the Building Official or his Dep
ONLY THE
IVO 1Y OTJ
WORK NOTED uty; and fees are paid, and receipt is ac
lmowledged in space provided.
INSPECTION
DEPARIWENT
CITY OF
EDMONDS
PR 6-1101
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