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BUILDING DEPARTMENT Applicant r
PERMIT APPLICATION Inside Heavy Lines
NANTO (OR NAM OF BUSINESS)
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ADDRESS
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CITY
TE—LEPHONE NUMBER
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ADDRESS
CITY
TELEPHONE NUMBER
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or Attoca I-Tur COP
NEW
1Z RESIDENTIAL
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AS
CLINE
NON-RILSIDENTIAL
SIGN
ADD
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
OR FILL
PENCE
( x Ft.)
REPAIR
PRE -MOVE
INSP.
.......... ..........
swim
POOL
;UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
f
1
tD SETBACKI
PERMIT
NUMBER
LET SETBACK
is- I M I'
REAR YARD SETBACK
VACANT SITE
YES 0 NO
VARIANCE NU
EXISTING STREET R/W ............ FT- DEFICIENCY
COMP. PLAN ST. R/W ............ FT. ...
0 YES
4 1 C3 kt_� \
TYPE or
I
Plan Check No .....................
EW
PROPOSED USE
04
BUILDING
PLOT PLAN (Indicate Building setbacks, abUttIn streets)
PLUMBING
07 5
HEAT & GAS LINE
L
FENCE
5v
SIGN
LRETAINING
WALL
SWIMMING POOL
6V
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that tt� 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-
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
THIS PERMIT
relating to Workmenle Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Your (Except DE310LITION'S which
ONLY THE
WORK NOTED
shall be completed in ninety days; 31OVED-IN BUILDING$ shall be com-
pleted In six months.)
_91G - NATURE rJQ%1VrN OR AGENT) D
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1207
This Perralt covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivowayu,
marquees, etc.) will require separate permission.
PROPERTY 0
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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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