710417.pdfBUILDING DEPARTMENT'
PERMIT APPLICATION
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ITAMla (OR NAME OF BUSINESS)
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%72 7_-3 70) W
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4 0"
0
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Applicant Fill
Inside Heavy Lines
NEW
RESIDENTIAL
El
GAS
LINE
NON-RESIDENTIAL
❑
SIGN
ADD
RETAINING
❑
DEMOLISH
EXCAVATE
PENCE
ALTER
❑
PILL
OR PILL
❑
(.x..........Ft.)
REPAIR
^
I I
PRE -MOVE
INSP.
^
I `
SWIM
POOL
DWELLING
UNITS
'\ 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-
lating construction; and In doing the work authorised thereby, no person
1 will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
11 NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months,)
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NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the publie domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
PERMIT
NUMBER
III
S- 1 a.
'710417
ols
C
❑ YES n, NO
EXISTING STREET R/W ... ........ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
❑ YES ❑ NO
❑ YES ❑ NO
THIS SITE IS LOCATED IN
TAX SHOULD BE CODED
Fee
Plan Check No .....................
BUILDING TO O
PLUMBING V
HEAT do GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
No.
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application Is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
THE
ONLY ORK NOTED
WORK
uty; and fees are aid, and receipt is ac-
p p
knowledged In apace provided.
INSPECTION DIRE 'OR'8 MATURE
DEPARTMENT
CITY OF Dw
EDMONDS �/
PR 6-1107
FILE
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