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BUILDING DEPARTMENi Applicant Fill
Inside Heavy Lines
PERMIT APPLICATION
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MAP NO.:
PERMIT
670485
NUMBER
LESS
6 -c-A-
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ILD BE TBACK
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LOT AREA
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1 0 YES M-N-0,
�iS!Wrg's'T'REET R/W ............ FT. DEFICIENCY IMS PROPERTY
COMP. PLAN ST. R/W ............ FT . . ........... ITT.
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES
INSPECTOR UIRED OCCUPANCY GROUP
[j YES
PLAN 9RECKE
AS
El RESIDENTIAL El GLTNE -REMA7!X
NON-RESIDENTIAL El SIGN
RETAINING
DEMOLISH M WALL
0 ALTER EXCAVATE PENCE
D OR FILL El ( .......... x .......... Ft.)
PRE -MOVE ErWIM
7 REPAIR A R INSP. POOL
ffS I —NUMBER 01
DWELLING
UNITS
NATURE OF WORK TO 13B
r Valuation Fee Receipt No.
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0
,7 Plan Check No .....................
-FR—O-POBED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets) PLUMBING
0 HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowle dge that I have read this application; that the In- TOTAL AMOUNT DUE
formation given In 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 rcgu- ATTENTION APPLICATION APPROVAL
lating coustruction; 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 This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep-
i ONLY THE
NOTE: P itone Year (Except DEMOLITIONS which AVORK NOTED uty; and fees are paid, and receipt Is ac-
a; DIOVED-IN BUILDINGS shall be com- kn
pleted In a m the.)
shall be cc etc in ninety owledged in space provided.
WN R 0 ENT) TE SIONTE—D— INSPECTION DIRECTOR' —
DEPARTMENT
CITY OF DAWhL;::1-
EDMONDS
NOTE: APPlicalit Slibicct to Plan Check Fcc
PR 6-1-107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate Permission-
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