700058.pdfBUILDING DEPARTMENT
Applicant Fill.
Insido Ileavy Lines
PERMIT APPLICATION
NAMID (Olt NAM13 OF BUSINEus)
M S70
MAILING ADDIihbli
05
CITY TELEPHONE NUMBEut
V
N'AMM
ADDRESS
CITY TELEI'IIONL KUMBER
NAM
�2
DDRESS
C TY TELEPHONE NUM13ER
Legal Description of Property (show Below or Attach Four Copies)
44
RESIDENTIAL
GJAIII.3
L N
NEW
ElNON-RESIDENTIAL
SIGN
DEMOLISH
RETAINING
WALL
ALTER
EXCAVATE
FENCE
1:1
OR PILL
PRE -MOVE
( ........ . X Ft.)
swim
REPAIR
E]
INSP.
D
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NAT LU)0 OF WORK TO
I I
BE DONE
% /
ill
PERMIT
NUMBER
/"� C' & r
REAR YARD
VACANT SITE
A
YES NO A
VARIANCE NUM13ER I
9W
EXISTING STREET n/W .... ....... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/1,V ............ PT. ............ FT.
REMARZ3.
C] YES [] NO
Plan Check No .....................
BUILDING
PLUMBING
PENCE
SIGN
N
RETAINING WALL
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 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 laws regu-
lating construction; and in doing the work authorized thereby, no person
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
THIS PER311T
relating to Workmen's Compensation Insurance.
AUTHORIZES
PE, Pe Limit One Year
ONLY THE
(Except DE31OLITION8 which
WORK NOTED
A filial be co?eo7tcd In ninety days; BIOVED-IN BUILDINGS shall be com-
d"'I
ipl,dbla
a Mon 5.)
m a
Olt AGENT)
DATB/sIGNE)5__
INSPECTION
UL
1�41Lj��70
DEPARTMENT
261
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PIL 6-1107
This Permit covers work to be done on private property ONLY.
Any oonAtruction on the public domain (curbs, sidewalks, driveways,
marquees, ale.) will require sepnrate permission.
[] YES [] NO
Valuation
No.
I 1 -7 - .09 A 1 /
APPLICATION APPROVAL
This application is not a permit until
eigned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in Space provided.
low
- 70.
rILE
"I
RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Lines
Final
RECORD OF INSPEGTIONS-
Dat6,Pas'sed-':'