710168.pdfti
1
BUILDING DEPARTMENT
PERMIT APPLICATION
POSTED ON KROLL MAP NO.: PERMIT
Applicant Flll NUMBER
Inside Ifeavy Lines JOB ADDRESS
NAME (oft ifthliffi UP 191111MOSS!
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�"t5F1 Ha F' CITY
G� TELEPHONE
NUMII&K
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t gts
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t
ADDRESS
a t
e
CITY TELEPHONE NUMBER
• NAM
i
ADDRESS /�
114Z7- n '
r , CITY TELEPHONE NUMBER
O
U STATE LICENSE NUMBER CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
x
0
w
0
a
e
c
❑ NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
❑
SIGN
ADD
❑
DEMOLISH
❑
WALL
ALTER
❑
EXCAVATE
OR FILL
❑
CE
(. EN
El
PRE -MOVE
..z_........Ft.)
swim
REPAIR
❑
INSP.
a
POOL
of �
PROP
a PLOT
O
/� k)
DWELLING
UNITS
t
I hereby acknowledge that I have read this application; that the In-
formation given In 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; MOVEDAN BUILDINGS shall be com-
pletad In six months.)
NOTE: Applicant Subject to Plat Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curb*, sidewalks, driveways,
marquees, etc.) will require separate permission.
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
ZONE
❑ YES ❑ NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
710168
REAR^ YARD SETS
VACANT SITE
❑ YES ❑ NO
DEFICIENCY THIS PROPERTY
Valuation
c
STREET
❑ YES
Fee
❑ NO
TOTAL AMOUNT DUE I 19,06
t O O Kp O f�
1 �l 0
ATTENTION APPLICATION APPROVAL
TIUS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ORK THE ut and fees are aid p
WORK NOTED Yi paid, receipt is ac-
Imowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR d-1107
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