730264.pdfBUILDING DEPARTMENT I Applicant FM
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PERMIT APPLICATION Inside Heavy Meg
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PERMIT
NAME (OR NAME OF BUSIN
Dallas H. Brumbi
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e � 19301 Olympic V.
Edmonds, Wn.
NAME
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CITY
NAME
owner
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CITY
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730264
REAR
730264
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YES ❑ NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
3ER ,
STREET R/W O 1
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY r
COMP. PLAN ST, R/W ............FT. FT. .
REMARRB
or
RESIDENTIAL ❑GAS
LINE
ElNON-RESIDENTIAL SIGN
IMMUMENE RETAINING
DEMOLISH WALL
EXCAVATE FENCE
OR FILL R t..6O.s...3.._Ft.)
�j PRE -MOVE ^ SWIM
I t INSP. I l POOL
DWELLING
UNITS
Fence
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 slate 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 Workman'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 months.)
3
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,
sO' •valks, driveways,
marquees,
ele.) will
require
separate]
lsalm.
■ ■
Plan Check No........_.._.._...
BUILDING
PLUMBING
FENCE
SIGN
RETAINING WALL
MOO
EXCAVATION OR FILL
:71 ii 4F 10 wo V`• 0111ZY 0_1 I III+
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR a-IIOI
THIS SITE IS
Valuation
APPLICATION APPROVAL
This application is not a permit until ,
signed by the Building Official or his Dep- l
uty; and fees are paid, and receipt Is ac-
lmowledged in space provided ` I