670111.pdfBUILDING DEPARTMENT I Applicant Fill.
PERMIT APPLICATION Inside Heavy Lines
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RESIDENTIAL
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GAS
LINE
NEW
NON-RESIDENTIAL
SIGN
ADD
RETAINING
ElDEMOLISH
WALL
ElALTER
0
EXCAVATE
OR FILL
D
PENCE
( ........ . x .......... Ft.)
REPAIR
F-1
PRE'MOVE
INSP.
swim
POOL
IUMBER OF STORLE13
NUMBER OF
DWELLING
UNITS
ft. ,
4
S.-
TED ON KROLL MAP NO.;
PERMIT
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NUMBER
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ADDRESS Ak
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C YARD SETBACK
STREET SETBACK
nEAR TARO SETBACK
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LOT AREA
VAC " SITS
YES
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.GHT
UU—ILDING AREA
VARIANCE 14UMBER 10,
FT -PLAN APPROVED
STREET n/W 01 ... FT. DEFICIENCY THIS PROPERTY 0
L,AN ST. R,/w .,g;dxv. FT.
CHE 0
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ONNECTION VE
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VFJT RMITI�52IBER
0 YES
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS JANE
t
PENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given in 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-
ATMNTION
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
THIS PERIMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com-
pleted In six months.)
HONATURE (OWNEFR—OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6.1101
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways,
marquees, etc.) will require separate permission.
I-,-
[3 YES '10-NO
Valuation I Fee I Receipt No.
0 0
00
0
11.2. 0 a-- r 3 - � 9-�
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-
knowiLdged in space provided.
DIRECTOR'S 81GNATURE
FILE
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