670009.pdfu1:r„
BUILDING DEPARTMENT
PERMIT APPLICATION
` NAME OR AMID OF HUB NE )
MAILING A.DDRES
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° CITY T
NAME
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Applicant Fill
Insido Heavy Lines
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PERMIT NUM670009
BER
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BIDE YARD SETBACK B EETTSETBACK REAR YARD SETBACK
SEc�ZONE � I Ry �s LOT AREA —I VAOAIi'I' S1 O
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84a It/W EXISTING STREET R/W0/.d...HT.
6 / COMP. PLAN ST, R/W ............FT.
C7 MARKS
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SPECIAL INSPECTOR
REQUIRED ( OCCUPANCY GROUP
13 YES wol o
PLAN CHECKED HY
1. prJl y RESIDENTIAL O INE
NEW .
I",fC"I 0 NON-RESIDENTIAL ❑ SIGN
ADD ❑❑ RETAINING
DEMOLISH
CE
ALTER .a OR AVATE FILL O (�...N...z.......... Ft')
REPAIR O PRE-MOVEINSP.O POOL
NUMBER OF STORIES NUMBER OF
DWELLING
/ I UNITS `
NA OF WORK TOO{!.BBE DONH
Valuation Fee Receipt No.
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.°. Plan Check No..._.._........._
PROPOSED UBE
BUILDING ;Z-6 D A�d
PLOT PLAN (Indicate Building setbacks, abuttin6 streets) PLUMBING 0
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BEAT A GAS LINE
FENCE
I _� \�� j SIGN
I RETAINING WALL
SWIMMING POOL
` DEMOLITION
�.� PRE -MOVE INSPECTION
..............
EXCAVATION OR FILL
TOTAL AMOUNT DUE ll
I hereby acknowledge that I have read this application; that the In- �tJ
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 APPLICATION APPROVAL
lating construction; and in doing the work authorized thereby, no person
win be employed in violation of the Labor Cods of the State of Washington TIHB PERMIT This application is not a permit until
relaubg to Workmen■ Compensation Insurance. AUTHORIZES signed by the Building Official or We Dep-
ONLY THE
NOTE: Permit Limit One Year (Except DE390LITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
sball be completed in ninety days; MOVED -IN BUILDINGS shall be oom- knowledged in space provided,
plated in 211 months.)
S ATURE (OWNER Oft ENT DATE SIGNED INSPECTION DIRECTOR'S SIGN
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/1117
1 � 7 DEPARTMENT /
o CITY OF
/ EDMONDS . Dw E67
NOTE: Applicant Subje to Plan Check Fee PR alloy
This Permit covers work to be done on private property ONLY, G
Any construction on the public domain (Curbs, sidewalks, drRroways, FILE /� 1�
marquees, etc.) will reVatre separate permission.
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