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POSTED ON KROLL MAP NO.*. PERMIT
BUILDING DEPARTMENT Applicant Fin 0 NUMBER 7004212
Lines /Ca -
PERMIT APPLICATION inside Heavy JOB ADDIVESS I
— 9 7W
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0 L CENSE NUMBER
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Description of Property7Bhow Below or
0_`NNEW
E_�RESIDENTIAL
0
GAS
LINE
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NON-RESIDENTIALJ
El
SIGN
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PENCE
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I I OR FILL
( .......... x ..........
REPAIR
PRE -MOVE
1:1 INSP.
swill
POOL
4UMBER OF STORIES NUMBER OF
DWELLING
UNITS
.ZATURE OF WORK TO BE DONE
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EXISTING STREET R/W
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indicated on Standard Drawing #103.
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CONNECTION
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0 YES YZJ NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
I
tRETAINING
N
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin 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 Inwa regu- ATTENTION
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 THIS PERMIT
relatiog to Workmenle Compensation Insurance. AUTHORIZES
at th
u
a In'
To
Ed Ith
U'y 4 or
"T r 'gu-
Y. no person
Washington
ONLY THE
14
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
Pleted In six months.)
a ION _D INSPECTION
;IGNATUR 1OWN M OR NT) E
DEPARTMENT
JDATE
7� CITY OF
EDMONDS
NOTE! Applicant Subject to Plan Check Fee IIR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
PROPERTY
Z
94
NO
Valuation Fee Receipt No.
CV (/V
79 P;
APPLICATION APPROVAL
This application is not a permit until
eigned by the Building Off lcial or Ws Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DIRECTOIVB SIGNATURE. n
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