670021.pdfC4
BUILDING DEPARTMENT Applicant ]Fill
PERMIT APPUCATION Inside Heavy LincH
NAME (OR NAME OF BUSINESS)
,671— T 11-0)MIAES
ADDRESS
-CITY TELEPHONE NUMBER
FPIPVIIIP.� 3-1 ��
0-6W/W 041
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PERMIT
NUMBER 6-70021
S' 710 - r -
:TBACK REAR YARD 81917BACK
VACANT SITE
ffYES 0 NO_
AREA I'VARIA
STRE4U/W
7'G STREET R/W ............ FT- 0
?HONE NUMBER nXIS N DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ....... .... FT.
I REMARKS
1/,,�V 7-e eel /0 Al
4U ECILE11-BY
inch Four Copies)
2 1 PERC. TEST PERMIT NITER I
1 M
Elm
E] RESIDENTIAL
El
GAS
LINE
NEW
NON-RESIDENTLALL
SIGN
RETAINING
DEMOLISH
WALL
ALTER
EXCAVATE
OR FILL
FENCE
( X Ft.)
.......... ..........
REPAIR
PRE -MOVE
INSP.
swim
POOL
FUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
.1
Plan Check No ............. .......
PROPOSED UBE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
'p-
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
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 doles the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workman's Compensation Insurance.
AUTHORUES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; 31OVED-IN BUILDINGS shall be Com-
pleted in nix months.)
rIONATURE (OyqqER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR (1-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curb@, sidawalks, driveways,
nuLnuees, etc.) will require separate perminsion.
M-frs' 13 No
Valuation Fee
4'..4
APPLICATION APPROVAL
No.
This application is not a permit until
signed by the Building official or his Dep-
uty; and fees are paid, and receipt Is ac-
kmowledged in space provided.
I
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