700003.pdfP, STED ON KROLL MAPP NO.: PE;',1m'T "OnO03
NUMBER
BUILDING DEPARTMENT Applicant Fill
P M17 inside Heavy lAnes JOB ADDRESS
=ERMIT APPLICATION 10 1 -% Q — I Q Ce t:L� (-:,Z a
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1 QL -T I QL
ONE LOT AJtEJL
0 YES WNO
�,.n ww!k- I VAIUANUM NUMBER ow
EXISTING STREET R/W ... ........ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ........... I . . . .... ....... M. —
or
[:] YES [] NO
aRESIDENTIA
GAS
LINE
D
NEW
1:1
NON -RESIDE TIAL
F_�
SIGN
ADD
Li
RETAINING
WALL
DDEMOLISH
ALTER
EXCAVATE
OR FILL
PENCE
( ........ x . ....... Ft.)
REPAIR
PRE -MOVE
INSP.
SWIM
POOL_
NUMBER OF
DWELLING
UNITS
0 YES 0 NO
Valuation I Fee
rim Check No ........
BUILDING
PLUhMNG
HEAT & GAS LINE
FENCE
B
P
I
SIGN
r
8
7
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E
I
N
T
U
A
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ON
EB
I
E
N
IN
G
G
'A" LUE
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t RETAINKING WALL
N
OL
SWIMMING PO 7
DEMOLITION
11 OVE:
PRE -MOVE INSPECTION
I
E XCAV TI OR
XCAVATION OR FILL
no 0
Z
IA
No.
I
TOTAL AMOUNT DUE
It n-
I hereby acknowledge that I have read Ulla application; that the In-
b�
y 0 r-
formation given Is correct; and that I am the owner, or the duly author-
aureg u-
a w5
I agree to comply with city and state laws regu-
APPLICATION APPROVAL
tzed agent of the owner.
ATTENTION
no person
lattng construction; and in doing the work authorized thereby, no person
be In violation of the Labor Code of the state of WasleLnEton
TMS PERMT
This application is not a pernilt until
will employed
relating to Workmen's Compensation --asuranoe.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Umit One Year (Except DEMOIATIONS AVch
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
I (,M_
shall be completed In ninety days; MOVEDAN BUILDINGS shall be com-
Ifflowledged in space p rovided.
pleted In oil months.)
E
RGNATURE (OWNER OR *PENT) DATE SIGNED
INSPECTION
D
—M-PIV "ONM
DEPARTMENT
W
M14
OITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check, Fee
7 r)
PR 6.1107
This permit covers work to be done on private property ONLY.
ex
Any construction on the public domain (curbs, sidewalks, erivewA72,
FILE
marquees, etc.) will require separate permission.
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