710040.pdf0
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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATIO/NA Inside Heavy Lines
NA
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MAILING ADDRIPS
177o 7-4 �.
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Legal Description of Property (Show Below or Attach Four Copies)4
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2 NEW /
ADD
ALTER
I I REPAIR
iUMBER OF S
IGAS
t
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1y 1
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LINE
LINE
NON-RESIDENTIAL
❑
SIGN
❑RETAINING
DEMOLISH
El
WALL
EXCAVATE
OR FILL
FENCE
(........ ..x.......... Ft.)
PRE -MOVE
INSP.
SWIM
POOL
fEB
INUMBER OF
DWELLING
UNITS
{ T E DONE
II A
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 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; MOVED -IN BUILDINGS shall be eom.
pleted In six months.)
II(jNATURE (OWNEI -_ ! AGENT) DATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
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.
I O PERMIT 710040
0
P NUMBER '7
'� 0
0 ` 7;,v
ID_
EXISTING STREET R/W
COMP. PLAN ST. R/W
GT//er—
❑ YES
Plan Check No .....................
As' i�l 1 ems'
BUILDING
PLUMBING
HEAT & OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
YES ❑ NO
DEFICIENCY THIS PROPERTY
0
_AJ I ❑ YES ❑ NO
Fee
TOTAL AMOUNT DUE
1
I / Q �� �►�%.a
8 7 61
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DIRECTO '8 SIGN URM
DEPARTMENT
CITY OF
EDMONDS
DATE
r I
PR 0-1107
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