710266.pdfl
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BUILDING DEPARTMENT I Applicant Fill _
PERMIT APPLICATION Inside Heavy Lines
NAME
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a MAILING ADDRESS
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CITY TELEPHONE NUMBER
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77
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1l RESIDENTIAL
❑
AS
LINE
❑ NEW
NON-RESIDENTIAL
❑
SIGN
El
ADD
❑
RETAINING
ElALTER
DEMOLISH
ATE
t❑
❑
ORXCFI
Lai
( zIO.C.Y tJ
REPAIR
❑
PRE -MOVE❑
SWIM
NUMDEk; OF 8TORI ES
NUMBER OF
DWELLING
UNITS
t
N
I
��R
YARD SETS
/
ZONE
N / 1,
M
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES ❑ NO
Plan Check No.
BUILDING
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
PERMIT
NUMBER
710266
CS. w
AR YARD SETS
tD
❑ YES .o'NO
DEFICIENCY THIS PROPERTY
CONSTRUCTION
❑ YES ❑ NO
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CITY OF EDMONDS. LOCAL SALES
TAX 6HUULD E CODED 31.04.
Valuation
Fee
go
No.
—
TOTAL AMOUNT DUE
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-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no Berson
'L will be employed in violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
Uty; and fees are paid, and receipt is ac-
ehall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
knoWledged in space provided.
pleted In six months,)
- n /
SIGNAT RE ( EIj OR A .NT) DATE SIGNED
INSPECTION
DEPARTMENT
DIR 'CTOR'S !Gj`)AT
64
,.
CITY OF
DATE
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PH 6-1101
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, eiGewalks, driveways,
FILE
marquees, etc.) will require separate ptrmleslon.