670325.pdfBUILDING DEPARTMENT
Applicant M
PERMIT APPLICATION inside Heavy Lines
I NAME (OR NAME OF BUSINESS)
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CITY I TELEPHONE] NUMBER
NAME
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CITY TELEPHONE NU �ER
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ADDRESS
CITY TELEPHONE NUMBER
POSTED ON KROLL MAP NO.: PERMIT
I /S� NUMBER 670325
JOB ADDRESS
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SIDE Ytj�D SETBACK I STREET SETBACK REAR TARD SETBACK
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USE ZONE LOT AREA VACANT SITE
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I IGHT I BUILDING AREA I VARIANCE NUMBER
EXISTING STREET R/W ............ FT.
COUP. PLAN ST. R/W ............ FT.
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0 YES
PLAN
GAS
RESIDENTIAL 1:3
LINE
REM-U
NON-RESIDENTIAL 0 SIGN
I I
RETAINING
WALL
DEMOLISH
EXCAVATE PENCE
ALTER
OR FILL I Ft.)
DREPAIR
.......... x ..........
PRE -MOVE swim
E] INSP. POOL
DWELLING
UNITS
WORK To BE DONE
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 COnatruction; and In doing the work authorized thereby. no person
will be employed In violation Of the Labor Code of the Slats Of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ahall be completed in ninety days; 31OVED-IN IIIJILDINGS shall be com-
pleted In six months.)
110 ATURE WWNER 01, AGENT) DATE SIGNED
NOTE: Applin�ut Subject to Plan Check Fee
Title 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.
,I I Z> A, 1 %
Plan Check No ............
DEFIOIMCY THIS PROPERTY
A/,
[3 YES [3 NO
Valuation I Fee
No.
BUILDING
0 0
PLUMBING
LT. 06
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
Tlds application is not a permit until
AUTHORIZM
ONLY THE
signed by the Building Official or his Dep-
WORK NOTED
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
rn 0-1107
1.3
FILE