670226.pdf.. ..... ..
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WING DEPARTMENT
RMIT APPLICATION
or
Applicant U f;�ic—c-u
F .. t
Inside Heavy Lines JOB ADDRESS
...... .-. --rnAMC I 11MAR YARD SETBACK
RESIDENTIAL
AS
ZIN
NEW
F]I
NON-RESIDEN , TIAL
SIGi:
ADD
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
OR FILL
PENCE
( .......... x .......... Ft.)
REPAIR
F1
PRE -MOVE
INSP.
swim
POOL
DWELLING
UNITS
t
N
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-
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; SIOVED-IN BUILDINGS shall be com-
pleted In six months.)
M
NOTE: APPlicant Sitliject to Plait Check Fec
__iiT, -rernilt covers work to be done on privnte Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveivays,
marquees, etc.) urill require separate permission.
EXISTING STREET R/W ............ FT -
COMP. PLAN ST. R/W ............ FT-
FIRE
0 YES 0 NO
Plan Check No.
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
VACANT SITE
0 YES [3 No
VARIANCE NUMBER P4
DEFICIENCY THIS PROPERTY
............ M.�l
O�O
CHECKED Ux Z
I 1W
[] YES E3 NO
Fee
TOTAL AMOUNT DUE 1 1 0 0 1 a?? q
ATTENTION APPLICATION APPROVAL
TIUS PERSUT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION DI T 'IL SIGN
DEPARTMENT
CITY OF DATE
EDMONDS
PR 6-1107
FILE
3
I
I
I Is
A