700560.pdfC.
BUILDING DEPARTMENT Applicant M
PERMIT APPLICATION Inside Heavy Lines
r
Z
No.: PERMIT
I NUMBER
L 0
YES 13 NO
EXISTING- STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
nn� PT.AW AM R/W -------- __FT. ............ FT.
TELEPHONE NUMBER
6 114 -18 /1450 MET SIZE
JITY LICENSE NUAdijiult 3 44 r(
REMARKS
Lv (Show Below or Attach Four Copies)]
NEW
0
ALTER
REPAIR
IF
RESIDENTIAL
NON-RESIDENTIAL 10
GAS
LINE
SIGN
RETAINING
WALL
PENCE
( .......... x .......... Ft.)
swim
POOL
F-1
RDEMOLISH
EXCAVATE
R OR FILL
E3 PRE -MOVE
INSP.
;UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
0 YES [] NO
REMARKS
rian Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
cks, abutting streets)
tRETAINING
PENCE
SIGN
I
WALL
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 to 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
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
TIUS PERMIT
relating to Workmen's Compensation Insur=ce.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED-XN BUILDINGS shall be oom.
pleted In six months.)
FIGNATU WN OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
,;Z/
CITY OF
EDMONDS
NOTE: Applicant fubject to Plan Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curb@, sidewalks, driveways,
marqueeso e1c,) will require separate permission,
I (
Valuation
1.
STREET IMPROVED
[3 YES 0 NO
Fee
No.
se�
APPLICATION APPROVAL
This applicaticn is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DIRECTORIS SIGNATURE , g
FILE
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