700271.pdfJ;
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BUILDING DEPARTMENT I Applicant ]Fill
PERMIT APPLICATION inside Heavy Lines
012
Alb /, /71 /`t`2 I, A/ H-o, I / & c
III ADDRESS
6 Z
VL
CITY TELEPHONE NUMBER
Q 1_94
STATE LICENSE NUMBER CITY LICENSE NUMBER
Z
or
PERMIT
NUMBER
YES 13 NO
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ 14�.
FIRE ZONE
I RESIDENTIA [3 YES
10 NEW PLAN
NON-RESIDENTIJAL SIGN
L_J ADD RETAINING REMARKS
ALTER
LJ
DEMOLISH
EXCAVATE
L_J
WALL
PENCE
REPAIR
11
El
OR FILL
PRE -MOVE
INSP.
( ........ . x .......... Ft.)
swim
POOL
I
ES
NUMBER OF
DWELLING
UNITS
13 NO
OF
[] YES [3 NO
Plan Check No .....................
Valuation
Fee
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I
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-
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 Washington
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 months.) / Z
Z-,( 571fe,- I � — N- I cD
NOTE: X'Pplicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
M
Z
No.
APPLICATION APPROVAL
This application is not a perInit until
signed by the Building Off Icial or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
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