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POSTED ON KROLL MAP NO.: PERMIT
NUMBER
BUILDING DEPARTMENT I Applicant Fill 700240
PERMIT APPLICATION Inside 11cavy Lines JOB ADDRESS
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CITY
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NAME
ADDRESS
CITY
TELETPH—ONE NUMBER
NAME
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CITY
HONE NUMBER
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
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RESIDENTIAL
El
GAS
LINE
NEW
1
El
NON-RESIDENTIAL
F1
SIGN
ADD
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RETAINING
WALL
DEMOLTSII
ElALTER
;9W
D
EXCAVATE
OR FILL
FENCE
( .......... x .......... Ft.)
El REPAIR
Q
PRE -MOVE
INSP.
SWIM
POOL
4UMBER OF STORFE-8-
NUMBER OF
DWELLING
UNITS de) A/ t--
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I hereby acknowledge that I have read this application: that the in.
formation given Is correct; and that I arn 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
will be employed In violation Of the Labor Code of the State of WanhIngton
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
Shall be completed In ninety days; MOVED -IN BUILDINGS Shall be com.
pleted in six nionthfi.)
NOTE: Applicant Subject to Plan Chlkk Fee
J
BUILDIN(
APPROVED
,CANT S'LTE
YES 13 NO
,RIANCE NUMBER
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
rr,
COMP. PLAN ST. R/W ............ FT- ............ FT.
REMARKS EEE
C CliE
HECKED BY
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This pennIt covers work to ho done on private property ONLY.
Any construction on the public domain (curbs, Sidewalks, driveways,
ma.rquees, etc.) will require separate permission.
NNECTION VERIFIED I
�MT PERMIT NU
TYPE OF CONSTRUCTION
13 YES
PLAN CHECKED BY
Finn Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Valuation
3
[j YES
Fee
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m
No.
TOTAL AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and. receipt Is ac-
Imowledged in space provided.
INSPECTION DIRECTOR'S SICLNATUAN
DEPARTMENT
CITY OF
EDMONDS DATE
PR 6-1107
FILE
OF
INSPEc,rlONS
1��qORD
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