710284.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
yUj ADDRESS
CITY
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Legal Dee
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Applicant Fill
Inside Heavy Lines
ElRESIDENTIAL
NEW
LINE
❑
NON-RESIDENTIAL
SIGN
ADD
RETAINING
❑
DEMOLISH
El
WALL
EXCAVATE
PENCE
ALTER
❑
FILL
OR FILL
❑
`x Ft.)
REPAIR
❑
IN PRE -swim
P.
.........
POOL
rUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
FIRE ZONE I TYPE OF
SPECIAL INSPECTOR RE
YES NO
Plan Check No ................. ...
_
BUILDING
PLUMBING
HEAT do OAS LINE
FENCE
tRETAINING
1
SIGN
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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 elate 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
styNt-Ve complet Noely days; MOVED -IN BUILDINGS shall be com-
lete In six nlhs.
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
PERMIT
NUMBER 710284
9� X/v
13 YES ❑ NO
DEFICIENCY THIS PROPERTY
............FT.
YES p No
THIS SITE IS LOUAI t:U WA
OF EDMONDS. LOCAL
TAX SHOULD BE
Q (,-_�L�
Valuation 7Fee
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
D1 TOR'S GNAT
DEPARTMENT
`
CITY OF
DATE
2_ �71
EDMONDS
PR 0-1107
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