670129.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
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MAILING ADDRES;B�,
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ADDRESS
CITY
NAM
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ADDRESS
CITY
Applicant Fill
Inside Heavy Lines
Legal Description of Property (Show Below or At
J'0-r 2-0 Rd-64J-C-:%.
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PERMIT
NUMBER 670129
�2 0" 7 —
USE ZONE LOT AREA
(R S� T I 1 0 YES [3 NO
EXISTING I STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT.
I= ZONE TYPE OF
SPECIAL INSPECTOR HE(
[:] YES [3 NO
PLAN CHECKED BY
GAS
NEW RESIDENTIAL LINE
ElNON-RESIDENTI" r SIGN
CTADD R F TAINING
0 DEMOLISH Li WALL
DALTER EXCAVATE PENCE
0 OR FILL ( .......... x .......... Ft.)
REMARKS
REPAIR PRE -MOVE swim
F� INSP. E] POOL
ES
NUMBER or
Lj
DWELLING
UNITS
NATURE OF WO TO BE DONE
&L 9 " V-0 1) VC, y-
Z
Plan Check No ............ . .......
-PROPOSED USE
0
PLOT PLANIIIndicate Building setbacks, abutting streets)
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
1 hereby acknowledge that I have read this application; that the In-
formation given Is correct: and that I am the owner, or the dUly allthOr-
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
ATTENTION
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
;ER OR AGPNT) D�A7'r I ZG
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
V
NOTE: Applicant Subject to Plan Cbeck Fcc
PR 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curts. sidewalks, driveways,
marquees, etc-) %vIII require separate permission.
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[3 YES [3 NO
Fee
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-
lmowledged in space provided.
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