700305.pdfI
BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
MAILING A.DDRE,118
( �w rii1�L
MEW
or
w Vol. r4; m (2(,
'L
GAS
NEW RESIDENTIAL ❑ LINE
LEINON-RESIDENTIAL ❑ SIGN
ADD ❑ DEMOLISH ❑ WALL NINE
® ALTER ❑ OROFILL E ElCE
(.EN..x......... Ft.)
REPAIR MOVE swim
❑ INSP. M POOL
DWELLING
UNITS
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; MOVEDAN BUILDINGS shall be com-
pleted Jn six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven
work to
be done
on private property ONLY,
Any construction an
the public
domain
(embe,
sidewalks, driveways,
marquees,
etc,) will
regalre
separate
permission.
PERMIT
NUMBER
vI &L
BACK
S
700305
ZL.+
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP, PLAN ST. R/W ............FT. ..........FT.
REMARKS
W:dSio IM0
REMARKS
Plan Check No. ........ _.......
401AF i•33iie
HEAT h GAS LINE
FENCE
SIGN
RETAINING WALL
s . • • _.
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 0-1107
Valuation
Mod
❑ YES ❑ NO
Fee
IN
APPLICATION APPROVAL
This application is not a permit unti
signed by the Building Official or his Dep
uty; and fees are paid, and receipt is ac.
knowledged in space provided.
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