700411.pdfPULMW ICROLL MAP NO. PERMIT
NUMBER
BUILDING DEPARTMENT Applicant Fin
Inside Heavy
PERMIT APPLICATION Lnels JOB ADDRESS
I NAME Wft tl*Mfi OF 014111iff""A / q 9 01 3
/ 7 -r,
o , 1
700411
VACANT SITE
13 YES E3 NO Z
14
VARIANCE NUMBER
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ 1��.
REMARKS
W%bldj�
f ( I 3,lzoel "I
D RESIDENTIAL
I
n
GAS
LINE
[:I YES
NEW
IE
PLAN CHE
ADD
1:1
NON-RESIDENTIAL
SIGN
RETAINING
1:1
DEMOLISH
WALL
REMARKS
EXCAVATE
FENCE
ALTER
1:1
OR FILL
( X Ft.)
REPAIR
El
PRE -MOVE
INSP,
.......... ..........
swim
POOL
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
[] NO
Plan Check No .....................
BUILDING
HEAT & GAS LINE
PENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
formation given in 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-
ATTENTION
latlng construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Vimit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
shal!.9 completed In ninety days; MOVED -IN BUILDINGS shall be com-
pIq(!d/j3,,sIx: months.)
31 N RE (OWNER OR r NT)
DATE 111ON4D
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
ATE: Applicant Subftict to Plan Check Fee
PR 6-1107
This Permit covers work to be done on Private property ONLY.
Any construction an the Public domain (curbs, sidewalks, drIV6w&YB,
marquees, etc.) will require separate permission.
rol
[] YES [] NO
Fee
I C-�_ 0 - 0 a IS41� 0
APPLICATION APPROVAL
This application is not a perntit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
. 7 1
0