670235.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
I NAME (OR NAME OF BUSINESS) 2 /
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Applicant FIR
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RESIDENTIAL JF�
GAS
LINE
21"NEW
NON-RESIDENTIA.L
SIGN
ADD
H
RETAINING
WALL
DEMOLISH
ALTER
EXCAVATE
OR FULL
PENCE
( x Ft.)
.......... ..........
REPAIR
PRE -MOVE
INSP.
swim
POOL
NU MBEK OF
DWELLING
UNITS
KROLL MAP 94U.:
PERMIT
NUMBER
670235
SETBACK
STREET SETBACK
REAR YAAV SETBACK
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0
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LOT AREA
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VAC�A MTN
6410
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[] YES
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I VARIANCE J
;W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY 0
COMP. PLAN ST. R/W ............ FT- ........... 1".
REMARKS
ED BY
CHECK Z
I N
METER SIZE I SERVICE SIZE I CLEARANCE CHECIC BY
REMARKS
TYPE
[] YES [] NO
Plan Check No .....................
RopqaED UUN &//
BUILDING
Q
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A51OUNT 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 wlth city and &late 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
TIUS PEnNIXT
relating to Workmell'S Compensation Insurance.
AUTHORIZES
ONLY TIEE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed In ninety days; 3IOVED-IN BUILDINGS shall be com-
pleted in six months.)
SIGNATURE (UNVINWt viyf�"ZL-T) SIGNED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Siibiect toylan Check Fee
PR 6-1107
This Permit covers work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
[] YES 13 NO
Valuation I Fee
W
1/1--s-0 I
No.
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-
Imowledged in space provided.
FILE
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