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BUILDING DEPARTMEN
PERMIT APPLICATION
NAME (OR NAME O((FF� BUSINESS)MAI, 1�
I4 ✓ I J I AA i
A/� DDRES8
r
z
✓�
1
} r•. 1
Q
>0
O
Applicant Fill
Inside Heavy Lines
or
❑ NEW
RESIDENTIAL
a
AS
LINE
ADD
NON-RESIDENTIAL
❑
SIGN
❑
DEMOLISH
❑
S I
WALL
El ALTER
❑
EXCAVATE
ORFILL
❑
PENCE
Ft.)
REPAIR
PRE -MOVE
INSP.
.x..........
SWIM
POOL
DWELLING
UNITS
R
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 authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workman'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.)
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.
N°'' I PERMIT
710448
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES ❑ NO
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
TRIG PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
❑ YES ❑ NO
DEFICIENCY THIS PROPERTY
❑ YES ❑ NO
SITE IS LOCATED IN'TH
CITY OF EDMONDS. LOCAL SAL S
TA3FS—HOULD BE CODED 31.
Valuation
Fee
00
No.
1a.4C,Ilb�aa
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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' RECORD OF INSPECTIONS
Date t Passed
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Is.Plbing (Partial)
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11 RECORD OF INSPECTIONS
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Drainage
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Fire Dept. f`
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