690409.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
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POSTED ON KROLL MAP NO.:
PERMIT
Applicant Fill
NUMBER
690409
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Agea Description of PFo-perty(Show BeldW or Attach Four
RESIDENTIAL
GAS
LINE
14 NEW
R
NON-RESIDENTIAL
SIGN
DADD
RETAINING
WALL
DEMOLISH
ALTER
D
EXCAVATE
OR FILL
FENCE
Ft.)
..........
REPAIR
M
PRE -MOVE
INSP.
SWIM
POOL
iUMBER OF STORIES
I NUMBER OF
DWELLING
UNITS
4ATURE OF VVORX T DONE
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YES 0 NO
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E KG'ST DEFICIENCY THIS PROPERTYJ
XISTING STREET R/W &A ... FT. S
COMP. PLAN ST. R/W 1.0 ... FT. ... 0 ..... IT.
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REMARKS
Drivewav sloi)es not to exceed7th7os7ee
indicated on Standard Drawing #103.
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C] YES
Plan Check No ........... . .......
BUILDING
PLUM33ING
HEAT & GAS LINO
ets)
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In-
formation given Is 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-
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 Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DENOIATIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be oom.
plated In six months.)
3IGNATURE T(
4PEAGENT DATE B;GNFjD
NOTE: Applicant Subject to Plan Check Fee
_jbig pernut covers work to be done on private PruTertY ONLY -
Amy construction on the public domain (curbs, sidewalks, drivaways,
marquess, ate.) wtH require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
J_
Fee
[3 NO
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 provided.
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