670384.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
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0-40,
]PERM T
NUMBER 670384
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UBE ZOL4E
Luw AREA
VACANT SITE
61 ;�
5
1 E3 YES
(3 NO
I
HEIGHT
BUILDING AREA
I VARIA
-Aok- Mewpq 7-y fd 4:=P
RESIDENTIAL GAS
NEW 114 R LINE
NON-RESIDENTIAL SIGN
RETAINING
DEMOLISH WALL
E] ALTER EXCAVATE PENCE
OR FILL ( .......... x .......... Ft.)
E] REPAIR PRE -MOVE SWIM
INSP. NUMBER -OF POOL
DWE
UNITS
-RA—TURE OF WORK TO BE DONE
STREET R/W
E313STING STREET R/W 1� '4.FT.
COMP. PLAN ST. R/W FT.
DEFICIENCY THIS PROPERTY
........... VT.
REMARKS
Z
METER SIZE SERVICE SIZE CLEARANCE
CHECK]11D BY
I I
om
I \�&_
[3 YES E3 NO
'4'#- 0��
Plan Check No ................ ...
PROPOSED UBI
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
PENCE
SIGN
Oe:7
le
RETAINING WALL
ID
SWIMMING POOL
OLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given in corr*ct; 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-
ATMNTION
lating construction; Lad In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Your (Except DE310LJTIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
IG (0
'�RORGENT) I
DATE 81 GNED
INSPECTION
C
f '47
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PH 04107
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate permission.
Valuation
13 YES C3 NO
IOUP
Fee I Receipt No.
j,
t
0
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.
D VIRC R klIGN
DATE -
FILE