700506.pdfUILDING DEPARTMENT I AppUcant FM
PERMIT APPLICATION inside Heavy Lines
St. Peter by the Sea Lutheran Church
-MAILING ADDRESS
1()1+5 Daley Street
Edmondso Wn. I rELEPHONE NUMBEK
or
NEW
1:RESIDENTIAL
1
-1
F
GAS
LINE
D---
NON-RESIDENTIAL I
r-=L
L4
SIGN
RETAINING
El
WALL
ALTER
D
DEMOLISH
EXCAVATE
OR FILL
F-1
FENCE
( x Ft.)
......... ..........
REPAIR
F_J
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 Umit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
/ 1 011-4)
NOTE: Aptlicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the pubtle dormdu (curbs, sidewalks, drivew'LYS.
marquees, etc.) will require separate percolation.
PERMIT
NUMBER
1212 — 9th Avenue North
R 3 12
E3 YES
NO
STRZ
E;WNGR/BWTREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. . ............ in.
REMARKS
TYPE OF
0 YES El NO
24
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Valuation
Do
[J YES Cl NO
3.00
No.
TOTAL AMOUNT DUE
3-00
ATTENTION
APPLICATION APPROVAL
TIUS PERMIT
This application is not a permit until
AUTHORIZES
Signed by the Building official or his Dep-
ONLY THE
uty; and fees are paid, and receipt is ac-
WORK NOTED
Imowledged In space provided.
INSPECTION
DLRECTOR"GN AALTVP417
DEPARTMENT
CITY OF
EDMONDS
DATE
o
PR 6-1107
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