690257.pdfr
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BUILDING DEPARTMENT
PERMIT APPLICATION
-�-4
511
Applicant Fill
Inside Ifeavy Lines
-54c
or
.01 ':71 /
:P PC.: PERMIT
NUMBER 690257
A/e 12-:6'
YES I"! NO
9!�= .4
ST
RICXVB/W
NUMBER EIC[STING STREET R/W ......... ST. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... XT. ....... .... LT.
REMARKS
R ri I % E 11 f) I'l " o 6'
Trl -4wa& - JE :5 *rD 00 19
NEW
RESIDENTIAL
El
GAS
LINE
LE
NON-RESIDENTIAL
ADD
1:1
DEMOLISH
JVJ
RETAINING
WALL
EXCAVATE
FENCE
ALTER
OR FILL
( ........ x . ....... Ft.)
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
CH OF
DWELLING
UNITS
?ATURE OF WORK TO BE DONE
I& , kl� _�
r � —
?� � PC ' / / —
C] YES [3 NO
Plan Check
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
tRETAINING
SIGN
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I hereby acknowledge Mat I have read this application; that the In.
formation given Is correct; and that I am the owner, or the duly author -
Iced 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
reigung to WorkinWa Compensation Insurance.
NOTE: Permit Lilmit One Year (Except DEMOIJTIONS which
abell be completed In ninety days; MOVED -IN BUILDINGS shall be oom-
plated In six months.) I
— t/7
NOTE: Applicant Subject to Plan Cbeck Fee
emstruction an the public domain (curbs, sidewalks, driveways,
m- u6es' etc.) Will require separate permust"L
[3 YES [3 NO
Fee
No.
M TT'nmv�M—OR, -FeLLrVL4P1 g- g? O-Z) , .0 0 K�EM
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TIM
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 4-1101
I / 0, io o V -1-6 z-
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.
'4�zl
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