700308.pdfF .
BUILDING
'U I LDING
DEPARTMENT
Applicant Fill
PERMIT
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APPLICATION
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1 NAME (OR NAME OF BU BINESS)
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976
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rATE LICENSE NUMBER
CITY LICENSE NUMBER
egal Description of Property (Show Below or Attach Four Copies)
ElADD
ElALTER
NEW RESIDENTIAL
NON-RESIDENTIAL
DEMOLISH
EXCAVATE
El OR FILL
REPAIR PRE -MOVE
INSP.
El
GAS
LINE
SIGN
RETAINING
WALL
PEZ40E
I .......... X .......... Ft.)
swim
POOL
TUMBER OF STORIES
NUMBER or
DWELLING
UNITS
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NUMBER
TE13
EXISTING STREET RIW ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ........ ... I.T.
[] YEF! [] NO
PI, �N CHECKED 13Y
or
Plan Check No ...................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
I
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
I hereby acknowledge that I have read this application; that the in-
In -
formation given In correct; and that I am the owner, or the duly author.
or"
Ized agent of the owner. I agree to comply with city and state lawn regu.
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ATTENTION
reon
lating construction; and In doing the work authorized thereby, no person
gton
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
le
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED-111 BUILDINGS shall be com.
Pleted In six months.)
SIGNATURE (OWNER OR AG
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDAIONDS
NOTE: Applicant Subject to Plais Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sldewalks� drivewaysp
marquees, etc.) will require separate permission.
Valuation
r] NO
Fee
-5-0
1 /9,7-0 1
No.
APPLICATION APPROVAL
This application is not a permit until
aigned by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
FILE