720452.pdfBUILDING DEPARTMENT I AppllcantFlll
PERMIT APPLICATION Inside Heavy Lines
NAMX (OR NAMB{ OF BUSINESS)
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NEW
ADD
ALTER
REPAIR
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3-5
..7. <OC-6 ,
GAS
RESIDENTIAL LINE
NON-RESIDENTIAL ❑ SIGN
❑RETAINING
DEMOLISH El WALL
EXCAVATE FENCE
OR FILL El (......... x.......... Ft')
lPRE -MOVE swim
INSP. M 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-
Ised agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the state of Washington
relating to Workmen'■ 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, drivewaye,
marquees,
etc.) win
require
separate
permission.
C
ll �
1 ON KROLL MAY Nth; PERMIT 7
NUMBER 20452
DRESS Our_ �•
�3�0— 75
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP, PLAN ST. R/W ............FT. ............FT.
REMARKS
STREET IMPROVI
❑ YES ❑ NO
❑ YES ❑ NO
PLAN CHECKED BY THIS SITE IS LOCATED IN THE
CITY OF F[]MoNns Loral SALES
TAX SHOULD BE CODED 31,04,
Rev►QUJCL I "104 L
Fee
Plan Check No, ....................
1ijihbRif'
rj1i1rvz fX&
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
A'21C 4Kiles;l9up �
PRE -MOVE INSPECTION
EXCAVATION OR FILL
No.
TOTAL AMOUNT DUE I I C7 Ib a I
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION DIRE OR'S SI66Gkk!!ATU�R
DEPARTMENT
a CITY OF
EDMONDS DATE
PR 6-1107
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