700092.pdfI
BUILDING DEPARTMEN1
PERMIT APPLICATION.
NAME to 14AMID OF BUSINESS)
— Z6LT 1401-le- &
MAI Off 7
� /I At S a'k'
Applicant Fill
inside Heavy Lines
p A! 1�
all
TELEPHONE NUMBER
or
NEW
GAS
LINE
SIGN
ADD
FJ
RETAINING
WALL
0
DEMOLISH
EXCAVATE
PENCE
ALTMR
El
OR FILL
( ........ . x . ........ Ft.)
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
)F WORK TO BE DONE
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-
lzed agent of the owner. I agree to comply with city and state laws regu-
latlng construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Your (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
I
KISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
TYPE
[3 YES 0 NO
Plan Check No .......
BUILDING
PLUM13ING
BEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION -
PRE -MOVE INSPECTION
EXCAVATION OR FILL
PERMIT
NUMBER
— , 7 00092
13 YES E3 NO
DEFICIENCY THIS PXLOPERTY
............ FT.
valuation
[:I YES 13 NO
Fee
0
0
Z
No.
AMOUNT DUE
MOU
en)
T
ATTENTION
APPLICATION APPROVAL
rTMAL
r 8 P RM
MS PERMIT
This application is not a pernilt, until
UWHOIUZI
AUTHORIZES
Signed by the Building Official or his Dep-
01 y Tin
ONLY THE
WO �i NOTI
WORK NOTED
uty; and fees are paid, and receipt is ae
knowledged in Space provided.
I ED j IN
1ATURE (OWNER OR AGENT) DAT SI SPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PE 6-1107
This Permit covers work to be done on private Property ONLY.
Any construction on the public domain (curb@, sidewalks, drivewaYst
marquees, etc.) will require separate Permission.
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RECORD. OF_INSPECTIONS
It
Date Passed
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Foundation
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RECORD OF; INSPECTIONStb(o
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Landscaping
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