680475.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
1-
CITY
A/Mlorl d
NAME
if 4P Vey
ADDRESS
CITY
Legal Description of Property (Show Below or
Q
W
RESIDENTIAL
E] NEW
NON-RESIDENTIAL
EJDEMOLISH
ALTER EXCAVATE
D OR FILL
REPAIR PRE -MOVE
F-1 INSP.
DWELLING
UNITS
lem
ApplIcant FM
Inside Heavy Lines
I/
GAS
LINO
SIGN
RETAINING
WALL
PENCE
( ........ x .......... Ft.)
swim
POOL
t
N
I
I hereby acknowledge that I have read Me application; that the In.
formation given In correct; and that I am the owner, or the duty author.
lzed agent of the owner. I agree to comply with city and state laws regu.
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
relating to Workman's Compensation Insurance.
NOTE: Permit Limit One Your (Except DE51OLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be oom..
plated In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
74
NOTE: Applicant Subject to Plan Cbeck Fee
This Permit coven *Work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driverways,
marquess, ate.) will require separate Porn-dasion.
I
EXISTING STREET R/W ..__..FT.
COUP. PLAN ST. R/W ............ FT.
[] YES 13 NO
Plan Check No ........
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIM NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUIE
PERMIT
NUMBER
680475
13 YES (3 NO
OR I i�
DEFICIENCY THIS PROPERTY
Valuation
13 YES 13 NO
No.
ATTENTION APPLICATION APPROVAL '
THIS PERMIT This application is not a permit until
AUTHORIZER
ONLY THE signed by the Building Official or his Dep-
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged In space provided.
INSPECTION DIREQTOR'S 13IGNATFRE
DEPARTMENT 44 P
CITY OF Y.
EDMONDS DATE
PR 6-1107
FILE
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