670194.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
N"S 4OR NAME DIP BUSIZ
VIM
t
Appncant Fill
Inside Heavy Lines
RESIDENTIAL
SID,
GAS
LINE
NEW
9
L
NON-Rr
L-1 ISIDENTIAL
SIGN
ADD
RETAINING
DEMOLISH
El
WALL
ALTER
EXCAVATE
OR FILL
PENCE
( ........ . x .......... Ft.)
REPAIR
PRE -MOVE
INSP.
D
swim
POOL
FE a-,
N or
DWELLING
UNITS
Z-s-/ -
YARD 811yrt
r7 �/ ' P-7
PERMIT
NUMBER 6-70 19
ve�
5 1 jy? I'
/ in
7 SITE
(3 NO
CE NUMBER
r1j;;4G I E;�REET R/W 4C ... FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W FT. ...
i:MARK
W
ETER SIZE I SERVICE 011E I CLEARANCE CBVjj�
WM&PLIM
01 , . 4,4L., � "l-
Ps CONNECTION VERIW BY
I AC14__ I
E3 YES
A -
Plan Check No ........... . .......
PROPOR UsE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLU3MNG
HEAT & GAS LINE
01
-7
FENCE
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 to correct; and that I am the owner. or the duly author-
ized agent of the owner. I &&rce 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 Code of the State of Washington
Tins PERMIT
n1gung to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
"I be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
JIGNATURE —(OWN NT) DATE SIGNED
ER OR E
le — //.— 4/.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit ' It to be done on Private ProPe"Y ONLY -
coven wor
A" construction on the public domain (curbs, sidevralks, driveways,
marquees, ate.) win require separate permission.
Valuation
0 YES
Fee
S_ 10- 0
C11
W'... o o I
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or Ids Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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