670145.pdfA
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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NEW
RESIDENTIAL
I
GAS
LINE
NON-REBIDENTLAL
El
ADD
SIGN
RETAINING
F�
DEMOLISH
WALL
EXCAVATE
f;Z7r
PENCE
ALTER
El
OR FILL
( x Ft.)
F� REPAIR
F�
PRE -MOVE
INSP.
......... ..........
SWIM
POOL
DWELLING
UNITS
e) 7 6
EXISTING STREET R/W ............ PT -
COMP, PLAN ST. RAV ............ FT.
[] YES [3 NO
Plan Check No ...........
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
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 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 doing the work authorized thereby. no person
will be employed in violation of the Labor "a of the State of Washington
Ting PER311T
relating to Workman's Compensation Insurance.
AUTIIOIUZrS
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
IVORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
3IGNATURE (OWNER OR AGENT) D SIGNED
INSPECTION
�TE
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
This Permit covers work to be done an private property ONLY.
Any construction on the public domain (curb%, sidewoMin, driveways,
nuarquees, etc.) %%III require separate Permission.
PERMIT
NUMBER
670145
YES
E] NO
DEFICIENCY THIS PROPERTY
YES C3 I -TO
00
0 0
2&4L.
APPLICATION APPROVAL
This application is not a pernilt until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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�W4FPllll1=
FILE /. —16- .
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_ro�STEDON P
PERMIT
BUILDING DEPARTMENT Applicant rill NUMBER"
Inside Heavy Lines 45
PERMIT APPLICATION JOB ADDRESS
NAME (OR NAM.E OF BUSINESS)
r7 j
SIDE YARD 13�1'"AUK STUEET
94: &4.- SETBACK REAR YARD BETB—ACK
MAILING ADDRESS
c, LOT AREA
0 USE ZONE VACANT SITE
PHOWE �NUMBLR
TELE
1 [3 YES [3 NO
P BUILDING AREA VARIANCE NUMBER
PLOT PLAN APPROVED
ADDRESS
CITY STREET R/W
TELEPHONE NUMBER EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY'
COMP. PLAN ST. R/W ............ Pr. ............ FT. 0
NAME
8
w& �FUPUFLY tallow �eiow or Attach Four Copies)
'W
NE RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
ADD
SIGN
DEMOLISH
RETAINING
WALL
ALTER EXCAVATE
PENCE
OR FILL
r;Z;l
V_'J
REPAIR. PRE -MOVE
( .......... x .......... Pt.)
INSP.
SWIM
POOL
11UZkt"lUlt OF UTORIES
NO �ER 01
DWELLING
-ITATURE
UNITS
OF WVICK TO BE DONE
j
PR6POSED USE
PLOT PLAN (Indicate Building setbYc�ks.
abuttina streets)
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I hereby acknowledge that I have read this 7 ap PlIcation; that the In.
formation given -in correct; and that I ant the owner, or the duly author-
lzed 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 �WLblngtanl
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DUMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
Pleted In six'months.)
NOTE: APPlicant Subject to Plan Check, Fee
This Permit covers work to be done on Private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivetrays,
notriluees, etc.) will require separate permission.
E3 YES 0 NO
11
Plan Check No.
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR PILL
TOTAL AMOUNT DUE
ATTENTI[ON
THIS PERMIT
AUTHORIZES
ONLY TBX
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDBIONDS
PR 6-1107
UkUGCKED BY
Valuation
0
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.
DIRECT
DATE
INSPECTOR
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