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PERMIT APPLICATION
I
NAME (OR NAME OF BUSINESS)
'cs IN\ C) I— N , %,vu
MAILING ADDRESS
CITY V,"C3 QDS TZ
or
kJAI
Inside Heavy Lines
-S i A
NEW
RESIDENTIAL
GAS
LINE
11
NON-RESIDENTIAL
SIGN
ADD
RETAINING
0
DEMOLISH
WALL
ALTER
0
EXCAVATE
OR FILL
FENCE
Ft.)
. ........
E] REPAIR
R
PRE -MOVE
INSP.
SWIM
POOL
r
DWELLING
UNITS
P NO.: PERMIT
NUMBER 690358
11:7� X - /)j A
AMNM
EXISTING STREET R/W ........... ST.
COMP. PLAN ST. R/W ............ FT.
[] YES [j NO
Plen Check No....
BUILDING
PLUMWNG
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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-
lzed agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
latlng construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
TMS PERMIT
relating to Workman's Compensation Insurance.
AUTHORIZER
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY ruE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six rponths.)
SIONAT k IER
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Appli"fiXt gu-_b�ject o Plan Check Fee
PR G-1107
This permit - coven worle to be done an private property ONLY.
Am construction on the Public damain (curbs, sidewalks, driveways,
marquees, ate.) will require separate pertninlon.
[3 YES
C3 NO
DEFICIENCY THIS PROPERTY
[] YES [:) NO
Fee
Z
Z
13. C9.- 0 15- 9
APPLICATION APPROVAL
This application is not a perInit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.