700124.pdfe
I R
BUILDING DEPARTMENT
PERMIT APPLICATION
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ADDRESS
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jT_AT3DL10ENS0 NUMBER
Legal Description of Property (Shov
407- /f
0, "
Applicant FBI
Inside Heavy Lines
9
or Attach Four Copies)
MAP NO.:
// -7 —,-.2 6 eo 64-#
PERMIT
NUMBER
.'12- !!�_
EXISTING STREET R/W ........... XT.
COMP. PLAN ST. R/W ............ FT.
ZONE
Ea —RESIDENTIAL
GAS 0 YES [] NO
LINE
NEW
I
PLAN CHECKED 33Y
E] NO
D
SIGN
a�Dl)
ElDEMOLISH
RETAINING REMARKS
WALL
ALTER
EXCAVATE
F] OR FILL
FENCE
( x Ft.)
F
........ . . ........
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF
DWELLING
UNITS
Plan Check No ..................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
tRETAINING
IWALL
SWIMMING POOL
DEMOLITION
PRE.MOVM INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
In-
I hereby acknowledge that I have read thin application: that the in-
or-
formation given In correct; and that I am the owner, or the duly author-
u-
ized agent of the owner. I ease to comply with city and state laws regu-
ATTENTION
on
lating construction; and In doing the work authorized thereby, no person
on
will be employed In violation of the Labor Code of the State of Washington
THIS PERBUT
relating to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Your (Except DEMOLITIONS which]
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
3IGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
0
_;70
DEPARTMENT
CITY OF
V
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit covers work to be done no Private property ONLY.
Any construction ou the public domain (curbs, sidewalks, driveways,
m,Lrquws, etc.) win require separMo permission.
, 7 00124
[3 YES
DEFICIENCY THIS PROPERTY
[] YES 13 NO
S�057_/,
Valuation I Fee
0
No.
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged In space provided.
01
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