700324.pdf__7
ON KROLL MAP No.: PERMIT
BUILDING DEPARTMENT Applicant Fin NUMBER 700324
PERMITAPPLICATION Inside Heavy Lines JOB ADDRESS
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CITY
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SIGN
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WALL
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DEMOLISH
EXCAVATE
FENCE
ALTER
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OR FILL
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.......... ..........
REPAIR
PRE -MOVE
INSP.
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POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
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UNITS
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HEIGHT
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PLOT PLA
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EXISTING STREET R/W
COMP. PLAN ST. R/W
TYPE
FIRE ZO TYPE OF CONS'
I �Z 01
PECTOR REQUIRE
[3 YES [] NO
REMARKS
Plan Check No .....................
BUILDING
PLUMBING
HEAT & G.&S LINE
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I EXCAVATION OR FILL
TOTAL AMOUNT DUE
T
I hereby acknowledge that I have read this application: that the In-
or
formation given Is correct; and that I am the owner, or the duly author-
rhIn
u
ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
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lating construction; and In doing the work authorized thereby, no person
glen
will be employed In violation of the Labor Code of the State of Washington
jj
THIS PERMIT
relating to Workmen's Compensation InBuran".
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
c,
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
plyted In six months.)
(OWNE 0 AGENTL
DATE SIGNED
INSPECTION
rLATUItE
7
DEPARTMENT
CITY OF
--ATE:
EDMONDS
Applicant Subject to Plan Chcck Fce
PR (1-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
W&
VACANT SITE
0 YES 13 NO
VARIANCF. NUMBI
(,'(A - ;5- 6 -7
DEFICIENCY THIS PROPERTY
Z
14
I [:] YES [3 NO
Valuation I Fee
rol
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No.
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1 /0 7, 75' 15�T?e
APPLICATION APPROVAL
This application Is not a permit until
signed by Uie Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DATjr1-
FILE
0
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