710498.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
J. f M
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Applicant Fill
Inside heavy Lines
MAILING ADDRESS
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CITY
T LEPHONEaIUMBER
NAME
ADDRESS
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CITY
TELEPHONE NUMBER
NAME
C4
ADDRESS
/
F
zO
TELEPHONE NUMBER
U
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/Yq-(6-a9-4A0
STATE LICENSE NUMBER
CITY LICENSE NUMBER
Legal Description of Property (Shaw Below or Attach Four Copies)
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RESIDENTIAL OAS
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LINE
NEW
NON-RESIDENTIAL ❑ SIGN
ADD
RETAINING
DEMOLISH
E FENCE
.
ALTER El OR FILL
El
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PRE -MOVE_ swim
j❑�
REPAIR INSP. ' t 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 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 six montha.1_
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.
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NO.t I PERMIT 710498
NUMBER
— o 0"-,V z
S'-
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES ❑ NO
Phan Check No .....................
BUILDING
PLUMBING
HEAT d; GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TfIE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
❑ YES ❑ NO
DEFICIENCY THIS PROPERTY
❑ YES ❑ No
THIS SITE IS L , , '�"i) T IH
TAX SHOULD BE CODED 31.04.
Valuation I Fee
APPLICATION APPROVAL
J
r
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.
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t . RECORD OF INSPEC710NS `fir {rs,t•„`S>yn r
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D to Passed:
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s Plumbing (Partial) d — — , I... ,
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t , ; .LS OF,INSPECtIONS ,rr
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D e'Passed
,..:: Drainag ., II
Sewer, a s;,
Parking T
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Landscaping
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