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BUILDING DEPARTMENT
PERMIT APPLICATION
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Applicant Fill
Inside Heavy Lines
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Legal Description of Property (Show Below or Attach Four Copies,
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SIGN
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RETAINING
EDDEMOLISH
El
WALL
ALTER
EXCAVATE
F1 OR FILL
FENCE
( x Ft.)
E3_4REPAIR
PRE -MOVE
F1 INSP.
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swim
POOL
DWELLING
IAJ 4 6 4 C UNITS
!URE OF WORK TO 23E DONE
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DLL MAP NO.: PERMIT
NUMBER
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'41�0 -- W/ ..41,
TNIACK STREET SETBACK
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WHEEWLK/W
EXISTING STREET R/W 51 ..FT.
COMP. PLAN ST. R/W.<e .. FT.
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Plan Check No ............. ......
BUILDING
PLUMBING
HEAT & GAB LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hireby 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-
iating 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 WorkmeWo Compensation insurance.
NOTE: Permit Limit One Your (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BVILMINGS shall be oom-
pleted in six months.)
SIGNATURE (OWNER ON AGENT) 1,F>ATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
Thin Permit covers work Who done oct private Property ONLY.
Any construction an the public docnaln (curbs, sidewalk@, driv&WaYs,
marquees, Cie.) will require separate permission.
DEFICIENCY THIS PROPERTY
Valuation
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Fee
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TOTAL AMOUNT DUE v, C) I( J-0 9
ATTENTI[ON APPLICATION APPROVAL
THIS PERMIT This application Is not a permit until
AUTHORIZES signed by the Building Off Icial or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DIRECTOR'S SIGNATU
DEPARTMENT
CITY OF
DATE 4��'
EDMONDS
PE 6-1107
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FILE
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