700514.pdfr
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8
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will I NJ a, POSTED ON KROLL MAP NO.:
Appilant Fill
BUILDING DEPARTMENT
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
NAME �'o
OF 0
ly
we
1:5 0
Y
12—
I
RM
PERMIT
NUMBER, 7005 14
a 0
4� A�
ff'(Td�
[] YES 0 NO
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ............ FT.
REMARKS
/�/ /*
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NUMBER
I
T5WHONE
lk.3'
_33 /'---'> METER
CITY LICENSE NUMB2
REBLAR
or Attach Four Copies)
DNEW
RESIDENTIAL
AS
CL;INE
U1,
NON-RESIDENTIAL
El
�"�
SIGN
RETAINING
r_1
WALL
DALTER
DEMOLISH
EXCAVATE
FENCE
R
OR FILL
( x Ft.)
REPAIR F�
PRE -MOVE
INSP.
.......... ..........
SWIM
POOL
rUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
TA�r_OF
WORK TOBE DONE
1 1
TYPE OF
0 YES 0 NO
,7
Plan Check No .....................
BUILDING
PLUMBING
streets)
HEAT & GAS LINE
PENCE
SIGN
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 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-
ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Slats of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
Limit One Year (Except DEMOLITIONS which
'ah rTd
ONLY THE
WORK NOTED
In ninety days; MOVED -IN BUILDINGS shall be com-
late
plate Ina no,
non a.)
110 AT7UgZ (0 NER OR AGENT)
DATE D
INSPECTION
71,(4, U
DEPARTMENT
grzjw
CITY OF
EDMONDS
NOTE: Appli"nt Subject to Plan Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
nuLrqueen, etc.) will require separate permission.
Valuation
I
Go
13 YES 13 NO
Fee I Receipt No.
0 6
PARM111row',
0010
APPLICATION APPROVAL "_
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
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OECORD OFt INSPECTIONS L lip
Date Pa'
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Drahage",
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Sewer,
Parking I d
Landscaping
Fire Dept.