670529.pdfI
BUILDING DEPARTMEN
PERMIT APPLICATION
!M
57
"Olt
low
or
A
—FO—STED ON KROLL MAP NO.: PER IT
NUMBER
7AppHeant Fill Po'
an
I Lis
nside Heavy es JOB ADDRESS
Hea Lines
_E' YARD SETBACK STREET SETBACK
A AIN S1
US
f/
r �rgdgj USE ZONE LOT AREA,
r ]LR
Z
MR
.EP R
UPRONE NU
670529
/S—
YES
E3 NO
- - __ - —1 - -
EN36TING STREET R/W .......... . FT- DmFlCjWCY THIS PROPERTY
COMP. PLAN ST. R/W ............ Fr. --FT. —
0 YES 0 NO
GAS
RESIDENTIAL LINE
NON-RESIDENTLAL SIGN
El __ I F� RETAINING
DEMOLISH WALL
ElALTER EXCAVATE VENCE
OR FILL ( ........ . x .......... Ft..
REMARKS
REPAIR PRE -MOVE swim
INSP. POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
79A—TURE OF WORK TO BE DONE
4S iLv T X_
PlanCheck No ............ .......
PROPOSED USE
BUILDING Git�
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
04
0
ft
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DVE
I hereby aanowledge that I have read this application; that the In-
formation given is correct; and that I am the owner, or the duty author-
lzed 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
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTZD
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
INSPECTION
DEPARTMENT
SIGNATW (OWNEit p�rENT)
-V
DA SIGNED
I
Z64A��� W)
/� —/ -
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done on private property ONLY.
Any construction oci the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate permission.
C3 YES 0 NO
t
Valuation I Fee
NEW
No.
7
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his Dep- q
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DIREL-JOR'S SIQNATTk%E
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