660551.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
4
WBER
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POSTED ON XROLL MAP NO.: PERMIT
660551
Applicant FIR
iL NUMBER
Inside Heavy Lines
JOB ADDRE8s
131DE YARD
SETBACK STREET BEWBAUK
111,11A�l YARD SETBACK
C'
C/
USE ZONE
LOT AREA
VACANT SITE
NPRONN NUMBIWt
NO
n- /) 0 1.) 1
I BUILDING A.KMA
I VARIANCE NUMBER
Ck
)NE 14 EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
I
OM-P. PLAN ST. R/W A! .... FT. 20-Y-V :�K.XT.
M�0'0-" M A " W.
or Atteell bOUr U01
*) o fT 0
kc(z ets 13 J V /sip IV
0
r- T
t��w
RESIDENTIAL
GAS
LINE
ADD
ALTER
E] REPAIR
NON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FULL
PRE-I&OVE
INSP.
SIGN
RETAINING
WALL
PENCE
( .......... x .......... Ft.)
swim
POOL
NUM33ER OF
DWELLING
UNITS
( I a/rLlk
[:] YES DINO I
Plan Check No ............ . .......
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
1� 41
31EAT & GAS LINE
'A(0
FENCE
0 t
SIGN
RETAINING WALL
SWIMMING POOL
0
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A51OUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given to 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
TMS PERMIT
relating to Workmenn Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
uQNATU_RE(OWNER OR AGENT) DATE SIGNED
INSPECTION
1'///�4
DEPARTMENT
I L
-r-L g;
CITY OF
Empammummummu�
EDMONDS
NOTE: Applicant Subicct to Plait Chech Fec
PR 6-1107
ThIs Penult covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
[] YES
No.
I 1� __? I 4�29 I
APPLICATION APPROVAL
This application is ,lot a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
j
I
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