670016.pdfI �� -A r�_
NUMBER
BUILDING DEPARTMENT Applicant Fill I 67UU 16
Inside 11cavy Lines JOB ADDRESS
PERMIT APPLICATION _J
NAME (OR NAME OF BUSINESS)
RTni.7 sm
YAAD SETBACK
�Ty TEL
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ADDRESS
CITY TELEPHONE NUMBER
_Ido�t Y-- 7 51el Z-
Description of Property (show Below or Aft
-)-7 P1
FA IM R
NEW RESIDENTIAL
GAS
LINE
ElNON -REBID
SIGN
DEMOLISH
RETAINING
WALT
ALTER EXrAVATE
FENCE
Ft.)
OR FILL
( .......... x ..........
REPAIR PRE -MOVE
INSP.
- —NUMBER
swim
POOL
ERS
OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
PROPOSED UBE
FL—OT FLkN (Indicate Building setbacks, abutting
I? o
IN
streets)
G A' -4
USE ZONE LOT A.RFA VACANT SITE
I I E] YES 13 NO
HEIGHT I UT LDING ARE& I VARIANCE NUMBER
EXISTING STREET n/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
0 YES [:] NO
Plan Check No ............
I hereby acknowledge that I have read this application; that the in-
formfLUou 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-
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
th
au
In'
Ihor-
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8h In ton
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE51OLITIONS which
co
shall be completed In ninety days; MOVEDAIN BUILDINGS shall be ]mm.
plated in six months.)
SIGNA OWNER OR AGENT) 4ED
NOTE: APPlicant Subject to Plan Check Fee
Title Permit covers work to be done on prIvAte property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) win require separate permission.
BUILDING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALT
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
AT=NTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORIC NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
DEFICIENCY THIS PROPERTY
Valuation
[] YES [J NO
Fee
I-s-
No.
I / o. I i ��-4 �
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-
knowledged in space provided.
() _ � 171
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