690441.pdfa
........... .... ..
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Ifeavy lAnes jo
I NAME (OIL NAME OF BUSINESS)
I
21
z
— Pei 6K-
or
47- oA koarlalw 001w, T)ej9k_07_ 4cle- 4
NEW
ADD
ALTER
REPAIR
I
N
RESIDENTIAL
N N-R
0 ESIDENTIAL
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( .......... x .......... Ft.)
swim
POOL
F1DEMOLISH
EXCAVATE
M OR FILL
PRE -MOVE
1:1 INSP.
TUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
V4
KROLL MAP NO.: PERMIT 6
NUMBER
97
VA-CANTSITM
C3 YES 13IMNOE I I
VARIANCE NU DER
Ck
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY I i
COUP. PLAN ST. R/W ............ FT. ............ IT.
REMARKS
[] YES [] NO
Plan Check No .........
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
I
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
1 ZV4
0 YES 0 NO
- �4 6 f4offl/I
Valuation I Fee I Receint No.
10
TOTAL AMOUNT DUE
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-
Ized agent of the owner. I agree to comply with city and state lawn ragu-
ATTENTION
APPLICATION APPROVAL
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
This application Is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
JVORK NOTED
uty; and fees are paid, and receipt Is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
ploted In six months.)
3IGNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DIRECTO
DEPARTMENT
CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (Curb$, sidewalks, driNcrWaYs,
m"queeo, etc.) will require sepamte permission.