710133.pdfi
POSTED ON KROLL MAP NO.:
''. BUILDING (DEPARTMENT
Applicant Fin
I NUMITER
PERMIT APPLICATION
Inside Heavy Lines
JOB ADDRESS
NAME
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(UMBER OF STORIES
NUMBER OF
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UNITS
7ATURE OF WORK TO BE DONE
710133
ARD SETBACK
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CE NUMBER
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STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
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FIR"E ZOI�FY I TYPE O NSTRUCTION BTREET IMPROV:
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SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
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REMARKS
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE.
FENCE
SIGN
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WALL
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ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin 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 Auto 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 Workmen's Compensation Insurance.
AUTHORIZES
(VOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
IIGNAT RE (OWNER Oft AGENT)
DATE 8I NED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject Plan Check Fee
PR 8-1107
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.
Valuation
06
Fee
m
3
No.
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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FPWA