670244.pdfIPARIMINI
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Applicant Fill
PERMIT APPLICATIM
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NAME (OR NAMIG OF BUSINESS)
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MAILING ADDRESS
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TELEPHONE NUMBER
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NAME
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ADDRESS
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CITY
TELEPHONE NUMBER
STATE LICENSE NUMBER
ITY LICENSE NUMBER
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Legal Description of Property (Show w or Attach Four Copies)
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GAS
E] NEW VS-1 RESIDENTIAL LINE
E] NON-RESIDENTIAL SIGN
15� ADD RETAINING
E] DEMOLISH WALL
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ElALTER EXCAVATE PENCE
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OR FILL ( .......... x ..........
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REPAIR PRE -MOVE swim
El INSP. POOL
NUMBER OF STORIES
I NUM13ER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
PROPOSED USE
PLOT PLAN (Indicate Building &"acks, abutting streets)
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I I hereby acknowledge that I have read this application; that the In-
here
formation given Is correct: and that I Elm the owner, or the duly author -
at ' g
ized agent of the owner. I agree to comply with city and state laws regu-
lating consitructlon; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
rel ng to Workmcn*a Competsation Insurance.
ati
NOLTE: Permit Limit One Year (Except nENIOLITIONS which
shall be completed in ninety days; 31OVED-IN BUILDINGS shall be com-
al
pleted In six months.)
SIPKkTURE (OWNER 0*.*4.ENT)
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DATE 8�71GN D
BUILDING D
NOTE: Applicant Subject to Plan Chcck Fcc
This Permit covers work to be done on private property ONLY.
Any construction on tile public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
N
tOLL MAP NO.:
PERMIT
NUMBER
670244
r,TBACK
STREET SETBAUM
REAR YARD SETBACT
LOT AREA
VAC�K SITE
Z
YES 0 NO
AREA
VARIANCE NUMBER
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'PROVED
CISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERI.
COMP. PLAN ST. R/W ............ FT. ...... —Xv.
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CHECKED
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IRE ZONE TYPE OF CONSTR
PECIAL INSPECTOR REQUIRED
I YES [3 NO
LAN CHECKEDXY
-inn Check No
3UILDING
?LUMBING
EIEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE-NIOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TIM
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
Valuation
Ej YES [3 NO
Fee
P&
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.
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