700115.pdfN KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT I"App=t F In INUMBER 00115
I NAME (OR NAME OF 13USINNUS) Jill, cz Linea I-) C_
JOB ADDRESS
PERMIT APPLICATION 711
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CITY
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NAME
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ADDRESS
CITY
NAME
ADDRESS
CITY
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Legal Descriptic
NEW
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DALTER
F_1 REPAIR
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- TELEPHONE NUMBER
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NUMBER CITY LICENSE NUMBER
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if PrODerty (Show Below or Attach Four Copies)
RESIDENTIAL
El
GAS
LINE
NON-RESIDENTIA
SIGN
DEMOLISH
0
RETAINING
WALL
EXCAVATE
OR FILL
M
FENCE
( ........ . x .......... I%.)
FPRE
-MOVE
INSP.
F-1
swim
POOL
DWELLING
UNITS
t
N
I
EXISTING STREET R/W ............ FT
COMP. PLAN ST. R/W ............ M
[:3 YES (3 NO
Plan Check No ...........
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIM NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
VACANT FBIT—E
[3 YES 13 NO
IIA VARIANCE NUMBER 04
DEFICIENCY THIS PROPERTY
Valuation
[] YES [3 NO
Fee Receipt No.
NT
TOTAL A31OUNT DUE
TOT"' L AM u
I horeby acknowledge that I have read this application; that the In-
formation give" Is correct; and that I sun the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
A N T
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
7
will be employed In violation of the Labor Code of the State of Washingon
E
THIS PER1%nT
T 8 P
This application is not a permit until
relating to Workmen-0 Compensation Insurance.
AUTHOItjzI
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
I
ONLY THE
K N I
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED-ILN BUUMINOS shall be ona.
Imowledged in space provided.
pleted In six months.)
IIGNATURE (OWNER OR AGEL4T) DATE SIGNED
I a :cTIO
INSPECTION
DEPARTMENT
OITY OF
DATE
EDMONDS
NOTE: APPUctnt Subject to Plan Check Fee
rn 6-1107
VrMs permit covcr@ work to be done on private property ONLY.
Any construction on the public domain (curbst sidewalkst drlveways�
rum
marquees, etc.) Will require separate permission.
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REC6RD OF INSPECTION'S
Date P�§sed
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