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BUILDING DEPARTMEN
PERMIT APPLICATION
N M (OR NAME OB B BINE89)
e.a rrr e
TE LICENSE NUMBER
Applicant M
Inside Heavy Lines
0 047-11
All
❑ NEW V-y BIDENTIAL ❑ 43
❑ NON-RESIDENTIAL ❑ SIGN
❑ ADD ❑ RETAINING
DEMOLIS:I ❑ WALL
ALTER ❑ O CFILE ❑ FENCE
s......... Ft.)
❑ REPAIA PRE -MOVE swim
❑ IN PI ❑ POOL
EXISTING STRZET R/W ....»......FT.
COMP. PLAN ST, R/W ..........eT.
72U492
DEFICIENCY THIS PROPERTY
Cx(5f
FIRE 204TYPE OF CONSTRUCTION, STREET IMPROVED
I
,NI YES O
(
SPECIAL INSPECTOR REQ
D
OCCUPANOY OR UP
� YE8 �NO
PLAN CHECKED BYO
ff
THIS SITE IS LOCATED IN THE
REMwRKe
TY OF EDMONDS, LOCAL SALES
TAX SHOULD BE CODED'A1.04
/ill T�12/d/Z
-to��L— ALe. "
PGA
70
Plan Check No...._.._...»......
BUILDING
PLUMBING
HEAT A GAB LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE•MOVE INSPECTION
EXCAVATION OR
TOTAL AMOUNT DUE
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 authoe-
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
TIUS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY
NOTED
shall be completed in ninety days; MOVED -IN ]BUILDINGS shall be oom-
pleted in six months.)
URE (OW R O AGEN A SIGNED
INSPECTION
rA ?/t.6..I&
DEPARTMENT
tv ia. >r
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
_
Pa e-II07
This Permit covers work to be done on private property ONLY.
Any construction on the publle domain (curbs, ridewalks, driveways,
marquees, etc.) will require separate permission.
-I!WK$011MAM
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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