700522.pdfI
BUILDING DEPARTMENT Applicant Fill
inside Heavy Lines
PERMIT APPLICATION
NAME (OW
?0 uo 0—
MAILING ADDRESS
q��,Z7, W,
CITY I �TET�.RPCKOINE NUMB—
D —11 6�_ 3L 3 OL 0
Z
8
Z
a
Z
w (\ P—C — b LA_t116eC
or
NEW
ALTER
REPAIR
RESIDENTIAL
I I
NON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FULL
PRE -MOVE
INSP.
F
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( .......... x .......... Ft.)
swim
POOL
11UMBER OF STORIES
NUMBER or
DWELLING
UNITS
M
:. / 7�-�
KISTING STREET R/W ............ FT.
COUP. PLAN ST. R/W ............ FT.
[3 YES
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
PERMIT
NUMBER
700522
0 "s
DEFICIENCY THIS PROPERTY
Z___A
STREET
0 YES
Fee
M
No.
1_7
U N T
TOTAL AMOUNT DUE
TOTAL AM 0
c2
gO
I hereby Le n n that in*
I hereby acknowledge that I have read this application; that the in.
' - it ow' a
4��l
c orr "a duly au
formation given Is correct; and that I am the owner. or the duly author-
a 'on given '3
form '
i
a 0 er a
an, 0, 'h late law u-
Ized agent of the owner. I agree to comply with city and slats lawn regu-
'zed ag
ATTENTION
A
APPLICATION APPROVAL
an r by n V"g on
thm7
lating construction; and In doing the work authorized thereby, no Verson
latin g construe a - 0 er
7
be a ployed in vtoll I or Washington
will be employed In violation of the Labor Code of the Biala of Washington
will m
E R M
THIS PERMIT
T I 18
This application is not a permit until
kman.
relating to Workmen's Compensation Insurance.
UTHORIZI
AUTHORIZER
A
signed by the Building Official or Itis Dep-
Mit Lit LITIONS which
OTE: Permit Limit One Year (Except DE51OLITIONS which
N 0
j
ONLY THE
NLY T110
O= NOTI
WORK NOTED
uty; and fees are paid, and receipt is ac-
led in JU S shall be com_
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
knowledged In space provided.
I
pleted In six months.)
r
SIGNATURE (OWNER OR AGENT) DATE SIGNED
13PECT
INSPECTION
DIRECTOEVS 81ONATURE
DEPARTMENT
OF
Y Ol
CITY
Cj�
EDMONDS
DATE%r��e
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
ZZ— 7
This Permit coven work to be done on private property ONLY.
Any construction on the Public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.