700553.pdfF BUILDING DEPARTMENT ___Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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NAME
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CITY M16EPRONE NUMBER
STATE LIUN149JAI NUMBER I CITY LICENSE NUMBER
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I Leffal namerintion of ProDertv (Snow lielow or Alto= irour u0ples)
NO.:
PERMIT
NUMBER 7000553
I
YES 13 NO
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i;�TS;�NG STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ IT- . ............ FT.
FIRE
RESIDENTIAL
A
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LINE
[j YES
NE�
PLAN
NON-RESIDENTIAL
SIGN
F1�"�
RETAINING
REMA:
WALL
DEMOLISH
EXCAVATE
FENCE
IOJIE
ALTER
OR FILL
El
( X Ft.)
1$14
.......... ..........
REPAIR
PRE -MOVE
INSP.
swim
POOL
C614-
ES
111�IMJSEK or
DWELLING
UNITS
I [] YES [3 NO
'OR REQUIRED OCCUPANCY GROUP
NO I )I= — —Z...
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Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGNS
I
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state lawn regu.
ATTENTION
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
shall be completed In ninety days; ZIOVED-IN BUILDINGS shall be com-
pleted In six months.)
31ONATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
9-1
�=,jeZ�
4.A?
CITY OF
EDMONDS
7- NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit covers work to he done on private property ONLY.
Any construction on the public domain (carbeg sidewalkag driveways$
marquees, etc.) will require separate permission.
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Valuation I;ee
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APPLICATION APPROVAL
This application Is not a permit until
migned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
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