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POSTED ON KRO" MAP NO.:
PERMIT
00531
r
DEPARTMENT
A FBI
Applicant Fill
ppil
7=7i
NUMB=
I
FBUILMING
A ATIO
PER141T APPLICATION
IT P LIC
Llines
Inside Heavy Lines
7
ion DRESS
—
7
j. A A14
AA
SIDE YARD SETISALM
STREET
SETBACK D SETBAC
U
Z
I
ElNEW
RESIDENTIAL
El
GAS
LINE
NON-RESIDENTIAL
F�
SIGN
ElRETAINING
El
WALL
0
DEMOLISH
DALTER
EXCAVATE
OR FILL
FENCE
( ....... _x .......... Ft.)
E] nEPAIR
PRE -MOVE
INSP.
SWIM
POOL
4UMBER OF STORIE13
NUMBER OF
DWELLING
UNITS
[] YES 0 NO
EXISTING I STREET R/W ............ FT- DEFICIENCY TI-118 PROPERTY
COMP. PLAN ST. R/W ............ FT- ............ I.T. —
0 YES [:] NO
M
rian Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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-
lzed 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; MOVFD-IN BUILDINGS Shall be com-
plet4d In six months.)
lTff URE (OWN R AGENT) DATE/IGNT
(90TE: Aj(�Zant,>5*1'bject to Plan Checle Fe�e
This Permit covers work to be done on private Property ONLY -
Any construction on the public domain (curbs, sidewalksp driveways,
marquees, etc.) will require sepamte permission.
/(9 0 PSI
[] YES 13 NO
Valuation I Fee I Receipt No.
1 CU. 9-
TOTAL AMOUNT DUE
0 go
ATTENTION
APPLICATION APPROVAL
THIS 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
Di C RIB SIGN
DEPARTMENT
774.1
CITY OF
EDMONDS
DAT2
PR 0-1101
I