710447.pdfBUILDING DEPARTMEN
PERMIT APPLICATION
to A ✓`e
Applicant Fill
Inside Heavy Lines
77y-
or
of ✓i 0
9 -D3o&
POSTED ON KROLL MAP NO.: PERMIT r
I NUMBER 10447
JOB ADDRESS
d 0
❑ YES
13 NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
[] YES i] NO
RESIDENTIAL OAS
❑ NEW El LINE
NON-RESIDENTIAL SIGN
❑ YES ❑ NO
PLAN CHECKED BYLOCATED
IN THE
CITY OF EDMONDS. LOCAL SA
ADD RETAINING
DEMOLISH WALL
ALTER EXCAVATE FENCE
OR FILL (........ ..x.......... Ft.)
REPAIR O INSPMOVE PWIM
OOL
REMARKS
TAX SHOULD BE CODED 31.04.
NUMBER OF BTORIE9
NUMBER OF
DWELLING
UNITS
W K TO BE DONE
mz:
Valuation
Fee
Receipt No.
tanCheck No .....................
BUILDING
PROPOSED USE
PLUMBING
0
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT a GAS LINE
Q' b
p
FENCE
SIGN
tRETAINING
WALL
N
1
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
—i
TOTAL AMOUNT DUE
1
I hereby acknowledge that I have read this application; that the in-
�+ i
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 constMCUOn; and In doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
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
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
This application is not a permit until
signed by the Building Official or his Dep-
utyi and fees are paid, and receipt is ac-
lmowledged in space provided.
IIGNATURE (O ER Oft A6 NT) DATE SIGNED
INSPECTION
DEPARTMENT
D;;� R'S 8;�UTr Amp-
S�
OITY OF
'
ro
NOTE: Applicant Su ject to Plan Check Fee
EDMONDS
DAT JT
9-3-o-01
PR 6-I107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sldewalks, driveways,
marquees, etc,) Will require separate permission.
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RECORD `OF l�1SP
Date Passed,
- !
.......
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__..._.
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