700038.pdfApplicant F111
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fiq NUMBEIt '00038
ADDRESS
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(4 M ti) 0 YES 0 NO
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��B;FNG_'S,T_REL"r R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/w ............ FT.
CITY LICENSff �_NUM�BER
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REMARKS
of property (Show Below or Attach Four Copies)
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PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CUNbKAULTX1UV
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V SPECIAL IN13PECTOR n�UI�REDUCUUPAVUY GROUP
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RESIDENTIAL LIN
El E PLAN CHECKED BY
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Y
El NON-RESrDENTIAJ SIGN
REM.ARKS
RETAINING
WALL
DEMOLISH
EI
PENCE
ALTER EXCAVATE mt
OR FILL . ........ Ft.)
PRE -MOVE SWIM
REPAIR INSP. POOL SaR o 5 6 S
NUMBER OF STORLE5
DWELLING
UNITS 1
Fee
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Plan Check No ............
BUILDING
PLUMBING
HEAT 6001�
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 this application; that the in-
formation given in correct; and that I am the owner, or the duly author-
ized 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
relating to Workman's Compensation InBU=Oe-
AUTHORIZES
NOTE: Permit Limit One Your (Except DEMOLITIONS which
074LY THE
WORK NOTED
shall be completed In ninety days; MOVMD-IN BUILDINGS shall be com-
pleted In six months.) I
SIGNA, RE (OwffiR—OR AGENT) DAT170 SIGNED
INSPECTION
DEPARTMENT
CITY OF
I
EDMONDS
NOTE: Applicant Subject to Plan Che'ch Fee
PR 6-1.141
This permit covers work to be done an private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, eta.) win require separate permission.
901
a0i
No.
I AA) Ov 163�2
APPLICATION APPROVAL
This application is not a perinit 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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