690377.pdf01
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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
it -
WA
or
I
5-,
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O-C AD
'97,
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NEW RESIDENTIAL
E] NON-RESIDENTIALJ
ADD
DEMOLISH
ALTER EXCAVATE
OR FILL
REPAIR PRE -MOVE
INSP.
AS
GLINE
SIGN
RETAINING
WALL
FENCE
( .......... x ......... Ft.)
SWIM
POOL
NUMBER OF
DWELLING
UNITS
f - I j
*2,<:5�
P M).. PERMIT
NUMBER 690377
V/ ;f,411 e,
6X IS A U It b E n Z WE b M, A
LOT AREA VAUA94E DEE"
1 [3 YES &-P�o
BUTL-DINGAREA I VARIANCE NUM13EK a,
KISTIN"TREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ 1". ............ FT.
FIRE
[3 YES
TYPE OF
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING
WALL
I
N
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 to correct; and that I am the owner, or the duly author-
lztd agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
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
THIS PERMIT
I
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED-XN BUILDINGS shall be com-
pleted In six rn��B.)
FIGNA7TU WNEft,
DATEPIGNED
NSPECTION
DEPARTMENT
�®RENT)
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This permit covers work to be done On private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marqueeso etc,) will require sepamte permission,
[] YES
Valuation I Fee
F__
No.
I IS / -7 -)
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-
Imowledged in space provided.
FILE