710479.pdfr
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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Linos
NAME (OR NAME OF BUSINESS) J
AT tJ O /1/&- S
M�AII
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aESS
ADDRESS /J
or
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EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
RESIDENTIAL
•�. LL
Z,l1,lT
YES
PLAN
NEW
ADD
NON-RESIDENTIAL
ElSIGN
NING
❑WALL
REMA7
DEMOLISH
EXCAVATE
FENCE
ALTER
❑
OR FILL
FILL
❑
REPAIR
ElINSP.
PRE -MOVE
..........Ft.)
swim
POOL
DWELLING
UNITS
t
I
I hereby acknowledge that I have read this application; that the in.
formation given to 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 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 nix months.)
— _I
DOTE: 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.
Plan Check No .....................
BUILDING
PLUMBING
HEAT do 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 a-1107
PERMIT
NUMBER
7104i9 1 j 1
YES
G>f 4
DEFICIENCY THIS PROPERTY
............FT.
(] YES 13 No
THIS SITE IS LOCATED IN THE
EDMONDS. LOCAL SALES
TAX SHOULD BE CODEn .-41 nn
Valuation i Fee
APPLICATION APPROVAL
No.
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.