710295.pdfG
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BUILDING DEPARTMENT
PERMIT APPLICATION
NAME ( _
Applicant Fill
Inside Heavy Lines
MAILINGR 88
lk70 AY iy
CITY TELEPHONE NUMBER
L% n.lyl,�t I 77j��o�2
NAME
id ADDRE88
Q
I CITY I TELEPHONE NUMBER
QN�
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Legal riescrlption of Yroperty (pnow Below or Attach Four Copies)
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ElNEW
I! RESIDENTIAL
GAS
LINE
ADD
NON-RESIDENTIAL
❑
SIGN
❑ DEMOLISH
El
WAS NINE
D
PENCEx
ALTER
O
ElRCFILL
PRE -MOVE
.......... Ft.)
swim
REPAIR
❑ INSP.
POOL
IUh113ER OF STORIES NUMBER OF
DWELLING
UNITS
rATURE OF WORK TO BE DONE
G/LL
.ED ON KROLL MAP NO.; PERMIT
( NUMBER 710295 `E
ADDRESS a`' 77///O
17 YES 13 NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
BY
❑ YES ❑ NO
[] YES NO
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THIS SITE IS LOCATED IN THE
CITY OF EDMONDS LOCAL SA ES
REMARKS TAX SHOULD BE CODED 31.04.
Permit issued subject to compliance with
_
Plan Check No .... ................
BUILDING
PLUMBING
HEAT k GAS LINE
FENCE
SIGN
1
RETAINING WALL
BWIMMIN6 POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application;J
In.
formation given In correct; and that I am the owner, or the hor-
ized agent of the owner. I agree to comply with city and stategu-
ATTENTION
sating construction; and In doing the work authorized therebrson
will be employed In violation of the Labor Code of the State ogton
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLIThich
ONLY THE
OTER'ORK NOTED
ehali be completed In nlaoty days; 3IOVED•IN IlO1LDINGB scom-
pleted In s onths.)
110NAT iE OWNER O JJCENT)
DATE
INSPECTION
DEPARTMENT
CITY OF
'ATE:
EDhiONDB
Algicant SuGiect to Plats Check Fee
PR 0-1107
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
Fee
10. tro
Cj
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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