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BUILDING DEPARTMENT
PERMIT APPLICATION
INAME (OR NAM OF BUS is)
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ITY
CITY
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NT—ATELICENSE NUMBER
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-Fo—STED ON KROLL MAP NO-: PERMIT
NUMBER
70469
Applicant Fill
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inside Heavy Lines
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SIDE YARD 13ETBACK
STREET SETBACK
REAit YARD BETE
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LOT AREA
SITE
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BUILDING AREA.
VARIANCE NU
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NEW
RESIDENTIAL
El
GAS
LINE
XON-RESIDENTI�JLF�
SIGI;
DRETAINING
0
WALL
ALTER
0
DEMOLISH
EXCAVATE
OR FILL
PENCE
( x .......... Ft.)
..........
REPAIR
Q
PRE -MOVE
INSP.
swim
POOL
NUMBER OF STORI
NUMBER OF
DWELLING
UNITS
al 1
I hereby acknowradg'o rhat i baveread this application; that the In.
formation given Is correct; and that I am the owner, or the duty author-
ized agent of the owner. I agree to comply with City and state laws regll'
luting 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 Vimit One Year (Except DE.11OLITIONS which
shall be completed In ninety days; NIOVED-IN BUILDINGS shall be com-
pleted In six months.)
31ONA RE (OWNER; LAGE DATE INED
NOTE: Applicant Subicct to Platt Check Fec
This Permit �vers work to be done on private property ONLY.
Any construction on tile public domain (curb$. sidewalks, driveways.
almrquoess etc.) will require separate permission,
OUTING STREET R/W ............ FT. DEFICIENCY
4
COUP. PLAN ST. R/W ............ FT.
[j YES
1 3/4- '(
M
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
Valuation
PROPERTY
YES M40
Z
Fee Receipt No.
I//, �2. L/) 0 W# IP37
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-
lmowledged in space provided.
FILE