700534.pdf.......... ......
BUILDING DEPARTMENT Applicant Fill
inside Heavy Lines
PERMIT APPLICATIO14
NAME
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MWA50712�%A
TELEPHONE NUMBEL
NUM13ER UITY —LICENSE NUM13ER
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RESIDENTIAL
D
GAS
LINE
NEW
SIDENTIAL
SIGN
ADD
RETAINING
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
FENCE
( x Ft.)
.......... ..........
REPAIR
PRE -MOVE
INSP.
swim
POOL
DWELLING
_N_A_TURF3_0F UNITS
WPRK TO BE D0.VE
t
N
I
I hereby acknowledge that I have read this application; that the In-
formation given Is correct: and that I nan the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and atate lawn regu-
lating construction; and in doing the work authorized thereby. no person
will be employed la 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; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
7
�, - 1 J11X9 1749
NOTE: Applicant Subject to Plan Check Fee
Thin Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquetst etcJ will require separate pernidaBlon,
PERMIT
NUMBER
mm
[3 YES 0 NO
!;�iS�9NG STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ......... f.-FT- . ............ FT.
REMARKS
J`0k
[3 YES 0 NO
REMARKS
0 YES 0 ITo
Valuation Fee —Receipt No.
Plan Check No .....................
BUILDING
PLUMBING
C:2 10-6
HEAT & GAS LIN
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
C
PRE -MOVE INSPECTION
PR
IM
XCAVATION OR FILL
E EX C V
OTAL AMOUNT DUE
T TOTAL
cQ 3,66
ATTEI NTION
A9
APPLICATION APPROVAL
TI
THIS PERMIT
This application Is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
4
ONLY THE
uty; and fees are paid, and receipt Is Be
WORK NOTED
W
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
knowledged in space provided.
-� 10 — _76
FILE