670515.pdfBUILDING DEPARTMENT Applicant Fill
inside Heavy Lines
PERMIT APPLICATION
A NAME (OR NAME OF BUSINESS)
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NAME
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Lew Description of —property (show Below
70.
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NEW
RESIDENTIAL
GAS
LINE
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SIGN
QDEMOLISH
F]WALL
RETAINING
F] ALTER
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EXCAVATE
OR FILL
FENCE
( x Ft.)
.......... ..........
F] REPAIR
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PRE -MOVE
INSP.
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SWIM
POOL
NUMBER OF
DWELLING
UNITS
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YES
LEIGHT
BUILDING AltZA
VARLILN C
PROVED
10"T R/W DEFICIENCY THIS PROPERTY
'XISTING STREET R/W ............ IT -
COMP. PLAN ST. R/W ............ rr- ......... FT.
tEMARKS
CHECKED BY
ALTER SIZE I SERVICE SIZE CLEARANCE
CHEEM—M By
REMARKS
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUM13ER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROV 59
-7-11 10� [3 YES
INSPECTOW REQUIRED
OCCUPANCY GROUP
Ej YES
rian Check No ................ . ...
PROPOSED USE
BUILDING
PLOT PLAN (Indffa—teBuilding setbaclis—,abutting streeta) PLUMBING
94
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
+j SWIMMING POOL
r,471-C P�oc% F. DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the 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 10Ms rogu- ATTENTION
lating construction; and In doing the work authorized thereby. no Vernon
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workmen-s Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED.IN BUILDINGS shall be com-
pleted In six months.) INSPECTION
SIGN,—kTURE(OWNER Olt AGENT) DATE SIGNED DEPARTMENT
4 CITY OF
EDMONDS
NO�E: APPlicant Subject to Plan Check Fee PR 6-1107
Thin Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
Fee
'1 4' 1 'S .'o d
1 ::�5 /�) 1�9 1 (if to I
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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