700232.pdfBUILDING DEPARTMENT InsApplicant VIII
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17NAME_(OR NAME OF BUSINESS)
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LICENSE NUB1131
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RESIDENTIAL
GAS
LINE
NEW
NON-RESIDENTIAL
SIGN
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
OR FILL
FENCE
( �x Ft.)
......... ..........
REPAIR
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PRE -MOVE
INSP.
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POOL
;UI%IBER OF STORIES
NUMBER OF
DWELLING
UNITS
9
ED ON KROLL MAP NO.:
FERMI
I NUMBER
700232
�DDREHS
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YARD SETBACK 9TREET SETBACK
YARD SETBACK
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I VARIANCE NUMUNlt
EXISTING'STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ 1"T.
TYPE
0 YES [] NO
Plan Check No .....................
P C e c I C N 0**'
'a h
IL D I N G
BUILDING
B U
I G
PLUMBING
P L U M B N
A 8 LI N E
HEAT & GAS LINE
H E A T G
PENCE
N
F E
C
IG N
SIGN
S
RETAINING WALL
N
SWIMMING POOL
EMOLITION
D M
V I SP
PRE -MOVE INSPECTION
N
XCAVATION OR FILL
E EXC V TIC OR FILL
TOTAL AISOUNT DUE
To"
In
I hereby acknowledge that I have read this application; that the in.
'h
a u or
formation given to correct; and that I am the owner, or the duly author-
'arr i
w 3 re gu
lzed agent of the owner. I agree to comply with city and state laws regu-
'zed
ATTENTION
r 10 Perm on
lating construction; and in doing the work authorized thereby, no person
him gton
will be employed in violation of the Labor Code of the Slats of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
[NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
be wm_
shall be completed In ninety days; MOVED -IN BUILDINGS shal I be com.
pleted In six months.)
_D
HIGNATURE(OWNER Oft AGENT) DATE SIGMED
Or
I NSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plait Check Fee
Fit 6.1107
This Permit coven work to be done on private Property ONLY.
Any construction an the public domain (curb#, sidewalks, drlvewwyg,
marquces, etc.) will require separate permission.
Valuation
0 YES 0 No
Fee
'_�]L L
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or Itis Dep-
uty; and fees are paid, and receipt Is ac-
knowledged In space provided.
D—IRECTOR-8, fflG_NATW , A
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