700518.pdfPOSTED
r=BUILDING DEPARTMENT Applicant ]Fill
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41 Inside Heavy Lines —iog —ADD
PERMIT APPLICATION
S
:2-
PERMIT
NUMBER
M
13 YES
tv
13 NO
EXISTING - STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
comp. PLAN ST. RIW ............ FT. ............ FT'
egal Description or Property (Show ilelow or Attach Four Copies)
TYPE 4
PERO.
REMAI
FIRE 2
SPECL
NEW
ADD
ElDEMOLISH
DALTER EXCAVATE
0 On FILL
REPAIR PRE -MOVE
E3 INSP.
El
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( .......... x .......... Ft.)
swim
POOL
0 YES
PLAN
REMAI
;UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
q 131(4 r ,
[3 NO
c k
Plan Check No .....................
P Is n C h e
D N G
BUILDING
B U I L I
I N a
PLUMBING
P L U M B
G
BEAT & GAS LINE
I IE A T
PE E
PENCE
I N C
8 If N
SIGN
RETAINING WALL
SWIMMING POOL
EMOLITION
D �M
RE -MOVE INSPECTION
P P MoVj
EXCAVATION OR FILL
EXCAVAT
TOTAL AMOUNT DUIC
I hereby acknowledge ULU I have read thin 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
taunt construction*. and in doing the work authorized thereby, no person
will be employed In violatlon of the Labor Code of the State of Washington TIMIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit rimit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be eorn.
pleted In six months.),., I
JIGNATURE (0 ENT) DATE SIGNED INSPECTION
DEPARTMENT
Crry OF
EDMONDS
NOTE: Applicasw' Subject to P14n Check Fee PR 6_1101
This Permit covm work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marque,es, etc.) �wtlll require separate Permission.
Valuation
I
M
0 YES [3 NO
Fee I Receipt No.
7
APPLICATION APPROVAL
This applicatlon 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.
0 - �)_,R - I o
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