710091.pdfr
Y;ruILDIN
MR,
'DEPARTMENT
APPLICATION
Applicant Fill
Inside Heavy Lines
ADDRES
TE PHONE NUMBER
TELEPHONE NUMBER
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TELEPHONE NUMBER
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Do
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NEW
ADD
ElALTER
REPAIR
or
El
AEBIDENTIAL
G8
LIANE
NON-AEBIDENTIAL
SIGN
❑ff%—�
DEMOLISH
RETAINING
WALL
EXCAVATE
OR FILL
El
FENCE
(......... x_........ Ft.)
PRE -MOVE
INSP.
M
swim
POOL
DWELLING
UNITS
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L MAP NO.: PERMIT
NUMBER
-7Gba,
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES
W -
❑ YES ❑ NO
DEFICIENCY THIS PROPERTY
❑ YES ❑ NO
544 JS F&_6-Z1U7LaV P44z S�
/3 6,(T y Capp" 4t
Valuation Fee Roo
Plan Check No........
BUILDING
PLUMBING
HEAT d: GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have road 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- 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 WorkmaWs Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
&hall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
.... ........�... ..o ...cw.m. , nemm oinwtmn INSPECTION
;iyL�4 .G L--"- i r " a OITY OF
EDMONDS
N TE: Applicant Subject to Plan Check Fee
PR a-Iloz
This Permit covers work to bq done on private property ONLY.
Any construction on the pubtic domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
MCIM
I- J
APPLICATION APPROVAL
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No.
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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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