670116.pdfBUILDING DEPARTMENT Applicant Fill
,...�,�:,.PERMIT APPLICATION Inside Ileavy Lines
(OR NAME OF BUSINESS)
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11 TIE"k-tiONE 24UMBER
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don of Property (Show below or Attach Four
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ElNEW
RESIDENTIAL
F-1
GAS
LINE
NON-RESIDENTIAL I
El
SIGN
ADD
RETAINING
DEMOLISH
WALL
EXCAVATE
FENCE
ALTER
El
OR FILL
El
( x Ft.)
REPAIR
PRE-31OVE
INSP.
.......... ..........
swill
POOL_
FUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
TATURE OF WORK TO BE DONE
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PERMIT
NUMBER (-)701 16
/V�3 "A,7 - � �61Aa� - —
SIDE YARD SVTIIArK I STREET SETBACK ItEAR XMID SETBACK
0 YES [] NO
EXISTING . STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ............ FT.
0 YES 0 NO
STREET IMPROVED
[] YES 0 NO
I
M
I
Valuation Fee Recelpt No.
Plan Check No .....................
PROPOSED USE
b
BUILDING
0 0
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
4
HEAT & GAS LINE
PENCE,
SIGN
Q,
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
3.
EXCAVATION OR FILL
TOTAL AIMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
od
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-
ArMNTION
APPLICATION APPROVAL
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 PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (EXCept DE31OLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; 31OVED-IN BUILDINGS shall be com-
knowledged in space provided.
pleted in six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
DIRECTO 8 SIGNATJURR
01
CITY OF
EDMONDS
NOTE: Applicant Snbject to Plan Check Fee
12
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks. driveways,
FILE
marquees, etc.) %vill require separate permission.
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RECORD OF lNsPEcTibNS
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Date Passed
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