680105.pdfOBTED ON KROLL PERMIT 680105
NUMBER
1UILDING DEPARTMENT
Indde HeRVY Unes JOB ADDRESS
PERMIT APPLICATION I
NA31LE (OR 14AKE OF BUSINESS) 0
REAR YARD
STREET SETBACK BETRAC
131DE YARD 13ETBAUX
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EXISTING STREET R/W DEFICIEW"JBI11 PROPERTY
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CITY YL
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STATIC LICENSE RU3_U=R CITY LICENSE Nu� ( t 5 1 t
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4 HAPLrW00Aj> &//jj./j4SE TYPE CONNECTION VERU17E
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Woo _S # - PERO. TEST
REMARKS
N TYPE OF CO bT STMET IMPROVI
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13 YES
SPEOLILL INSPECTOR REQUIRED OCOUPANCY
0 YES 0
GAS
RESIDENTIA E LINE PLAN CHECKED BY
NEW 0NON-RESME TIA SIGN
RETAINING REMARKS
DEMOLISH 0 WALL
ALTER EXCAVATE PENCE
OR FILL E] ( ........ . x ......... Ft.)
REPAIR PRE -MOVE SWIM
INSP. POOL
NUMBER OF STORIES —1 NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Plan Check No ..................
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NG
BUILDING
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HEAT & GAS LINE
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SIGN
ION
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RETAINING WALL
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swim No POOL
EMOLITION
D EM
PRE -MOVE INSPECTION
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EXCAVATION OR FILL
OTAL AMOUNT DUE
T TOT �O�
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-
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 PERMT
nlaUng to Workmen's Compensation Iwu=ca-
AUTHORIZES
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVEDAN BUILDINGS shall be oom-
pleted in six months.)
—010 (OWNER OR—AGJDNT) IJA:17B; SIGNED
WA_F.n_j
IN SPECTION
DEPARTMENT
,.yw"4
CITY OF
EDMONDS
NOTE: Applicanhubject to Plan Check Fee
PR 6-1107
This permit coven work to be dons OR private property ONLY.
Any compincilon an the public domsfs (carbs, sidewalks, driveways,
marquees, ek.) win require separate permission.
Valuation
Fee
mat;
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-
Imowledged in space provided.
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