710032.pdf•
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POSTED ON KROLL MAP NO.:
BUILDING DE710032
PARTMENT (.J NU BIER
Appllcunt Fill
PERNUT APPLICATION Inside Heavy Lines JOB ADDRESS
12 3 / 90
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Legal Descrlp
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[:I YES ❑ NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
04'/JOROd
RESIDENTIAL ElGAS
LINE
❑YES NO
NEW PLAN CHECKED BY
NON-RESIDENTIAL ❑ SIGN
ADD RETAINING REMARKS
DEMOLISH WALL
ALTER ❑ EXCAVATE
ORILL F(E..... Ft.)
REPAIR ❑ PRE-INSP.
SWIM
❑ POOL
IUMBER OF STORIES NUMBER OF
DWELLING �� �% A'
UNITS /.� tl1B�K./1 &,e l
Lbutting streets)
t
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LI
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have road this application; that the ln-
TOTAL AMOUNT DUE
formatlon given Is correct; and that I am the owner, or the duly aulhor-
Ized agent of the owner. I agree to comply with city and state laws regu-
lating
toting construction; and In doing the work authorized thereby, no parson
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
TIi18 PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
'
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE
sha} a completed 1n ninety days; MOVED -IN BUILDINGS shall be com-
pl l n six months.)
WORK NOTED
INSPECTION
I URE (OWNERAG
ATE iG 'D
—
17;�
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DEPARTMENT
CITY OF
EDMONDS
rE: Ahplicau hi to Plan Check Fce
rR d-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
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D YES ❑ NO
UPANCY GROUP !
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ddc.91 �
LEA {
1 Fee r Recelpt No. i
APPLICATION APPROVAL
This application 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.
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