710372.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
NAME OF BUSINESS)
y �%ER.G/�► A . L Ek.Y
„f MILLI N(l ITTnL.en
NEW
ADD
ALTER
REPAIR
i
or
Applicant Fill
Inside Heavy Lines
-iaS:2
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
❑
SIGN
RETAINING
DEMOLISH
WALL
EXCAVATE
OR FILL
FENCE
(........ac_........Ft.)
❑PRE
-MOVE
INSP.
I `
SWIM
POOL
DWELLING
UNITS
A
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 Iowa regu-
MIMS 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 Your (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
71
NOTE: Applicant Subject to Plan Check Pee
This Permlt coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
l
o-
.J_ D
C
PERMIT
NUMBER
5.c &
P SETBAi
.afo
EXISTING STREET RAW ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES
.
Plan Check No.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR d-1107
REAR YARD BETE
moo/
❑ YES jff NO
DEFICIENCY THIS PROPERTY
ILEARANCE CHECKED BY
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.
r `0 ^ 7/
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