690345.pdfelf
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DEPARTMENT
POSTEF ON-KROLL MAP NO.:
PERMIT
N UMBER 690345
BUILDING
AppIlciant Fill
.
PERMIT APPLICATION
Inside Heavy Lines
JOB ADDRESS
NAME (OR NAME OF DUBIN
4466 X 4=
46"
&A Ot
SIDE YARD SETBACK STREE
REAR YARD BETE
SUAILIND ADDI.ASS
i�]
DNEW
RESIDENTIAL
NON-nESIDENTIA.L
DEMOLISH
ALTER
EXCAVATE
El OR FILL
REPAIR
PRE -MOVE
El INSP.
DWELLING
UNITS
I
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( ........ X . ........ Ft.)
SWIM
POOL
EXISTING STREET R/W ........... FT.
0 YES [:] NO
REMARKS
2? 4A,;. Pe,.a- j-7--v
Plan Check No ..................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given to correct; and that I am the owner, or the duly author -
tied 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 Umit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be oom.
pleted In six months.)
I DATE BIGNE
IJUNKTURE _(OWNER OR AGENT) . D
NOTE: Applicant Subject to Plan Check Fee
_jW_s permit covers work to be dome an private property ONLY.
Amy construction an the P111416 45011MAIR (corbs, sidewalks, drivvw"16
marquess. etc.) will require separate permission.
THIS PERBUT
AUTHORIZES
ONLY THE
WORK NOTIED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 41-1107
13 YES
E3 NO
DEFICIENCY THIS PROPERTY
I
Valuation
[3 YES [:] I-ro
Fee
10.5 0
APPLICATION APPROVAL
No.
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
Imowledged in space providedL
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RECORD OF INSPECTIONS
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