700474.pdfZ
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BUILDING DEPARTMENT I Applicant FM
PERMIT APPLICATION Inside Heavy Lines
NAME-LOR, AM&.QF BUSINESS)
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GAS
LINE
NEW
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SIGN
RETAINING
DEMOLISH
WALL
ALTER
EXCAVATE
OR FILL
FENCE
I X Ft.)
REPAIR
PRE -MOVE
INSP.
......... ..........
swim
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; MOVED -IN BUILDINGS shall be com-
pleted In six monthm.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done On private property ONLY.
Any construction an the public domain (curb@, sidewalks, driveways,
marquees, etc.) will require separate pt-rallision.
ROLL MAP NO.: PERMIT
I NUMBER
C- Ix I
i
700474
YES 13 NO
EXISTING- STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ............
REMARKS
.� /�, " I
REMARKS
TYPE CJWNECTION
[] YES [3 NO
REMARKS
Plan Check No .....................
BUILDING
PLUMBING 0
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
[:] YES [:] NO
Fee [�R
Lem
TOTAL AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THIS PERMT This application Is not a permit until
AUTHORIZES eigned by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
INSPECTION 111 0 ""3 Rg`
DEPARTMENT
CITY OF
EDMONDS DATE
PR 6-1107 0
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