670420.pdfJ #
BUILDING DEPARTMENT Applicant 'Fill
PERMIT APPLICATION Inside Heavy Lines
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�"Sm NUMBER T—CITY LICENSE V
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KROLL MAP NO.: PERMIT 7n
NUMBER 4 2' 0
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SETBACK STREET UNKOACK REAR TARD SET15Ak!k
OT AREA
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ARVIA I VARIANCE NUMDA�n
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EXISTING STREET fr//W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/`W ..... ...... FT- .......... FT.
REMARKS
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RESIDENTIAL
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SIGN
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DEMOLISH
RETAINING
WAI.L
DEXCAVATE
OR FILL
PENCE
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PRE -MOVE
INSP.
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POOL
DWELLING
UNITS
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I hereby acknowledge that I have read this application; that the in.
formation given to 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 Workman's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; BIOVED-IN BUILDINGS shall be com-
2 ted in six months.)
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NOTE: Applicant Subject to Plait Cbeck Fee
Thin Permit covers work to be done on private Property VA�X.
Any construction an the public domain (curbs, sidewalks, driveways,
marquee@, etc.) will require separate permission.
[3 YEB [3 NO I
Plan Check No....
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
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0 YES [:] NO
Valuation I Fee I Receipt No.
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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.
FILE
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