710556.pdfP08TED ON KROLL MAP NO-: PERMIT
BUILDING DEPARTMENT I Applicant Fill NUMBER
PERMIT APPLICATION Inside Heavy Lines I
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EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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PLAN CHECKED BY
mi THIS SITE IS LOCATED IN THE
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TAX SHOULD BE CODED 31.04.
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Plan Check No .....................
BUILDING
PLUMBING
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FENCE
SIGN
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ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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-
ATTENTION
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
THIS PERMIT
relating to Workmen's Compensation Insurance,
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
MATURE (OWNER OR AGEN DATE SIGNED
INSPECTION
//_�
7
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applican uLject to Plan Check Fee
PR 6-1107
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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Valuation Fee I Receipt No.
'ADO t 0o
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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.
FILE