690464.pdfC
BUILDING DEPARTMENT Applicant FM
Inside Heavy Lines
PERMIT APPLICATION
NAMM (OR NAME OF II INN511)
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CITY TXJXPUONE NUMBER
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RESIDENTIAL
NON-RESIDENTIAL
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LIN
SIGN
EJADD
ALTER
F]
DEMOLISH
EXCAVATE
OR ]PILL
RETAINING
WALL
PENCE
( ......... x . ........ Ft.:
REPAIR
F1
PRE -MOVE
INSP.
El
SWIM
POOL
NUMBER OF
DWELLING
UNITS
0 1/
PERMIT
NUMBER
/06 � 1.
13 YES
6
No
EBER 101
- ____ -1 � -
EXISTING STREET R/W ........... XT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... 1". ....... .... IZT.
C4
IE
FIREjr I TYPE OF CONSTRUCTION
ST T IMPROVED
YES 0 NO
SPECLALL INSPECTOR REQUIRED
0 YES 0 NO
OCCUPANCY GROUP
PLAN CHECKED BY
REMARHB
Plan Check No .........
E, BUILDING
PLUMBING
HEAT & GAS LINE
tRETAINING
PENCE
SIGN
WA.LL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
'I
Lill r
'o
formation given In correct; and that I am the owner, or the duly author-
reg u-
tzed agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
� ermon
lating construction; and in doing the work authorized thereby, no person
ngton
will be employed in violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmenla Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE51OUTIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -]IN BUILDINGS shall be com-
pleted In six months.)
3ir
DATE SIGN]jD
INSPECTION
r2ENT)
.
0,
DEPARTMENT
,,ffER
CITY OF
EDMONDS
NOTE: Applicalt Subject to Plan Check Fee
FU 0-1107
This rermit covers work to be done on Private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate permission.
t 0-10 1 - 1-7, 4_0
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APPLICATION APPROVAL
This application Is not a perntit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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