700290.pdf,UILDING DEPARTMENT
�IPERMIT APPLICATION
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Legal Description 01
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NEW
ALTER
REPAIR
Applicant F111
Inside HeaVY Lines
'743-3`719
or
-.67-
RESIDENTIAL I
R
GAS
LINE
NON-RESIDENTIALI
Q
SIGN
DDEMOLISH
0
RETAINING
WALL
EXCAVATE
OR FILL
FENCE
( .......... x .......... Ft.)
PRE -MOVE
INSP.
El
swim
POOL
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Covev- -Po�- DjQ G 1'��
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-
isting 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 WorkmerVs Compensation Insurance.
NOTE: Permit Umit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE 8101,
612 V/70
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (carbs. sidewalks, driveways,
marquees, etc.) will require separate permission.
PERMIT
NUMBER. 700290
13 YES 10 NO
E)aSTIN3 , STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ............ FT.
ZMARKS
[] YES -0 NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
13IGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIIS PERMT
AUTHORIZES
ONLY THE
WORK NOTZD
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1101
Valuation
[] YES 13 I -TO
Fee
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.
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