670542.pdfBUILDING DEPARTMfil
PERMIT APPLICATION
RX" (on NAME OF BUSINESS)
GLE-1�4 DALE CONSTRU071014 CO-
_11A �LJQ A�DDRESS
23728 91st P1. Wost
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CONSTRUCT101-1 CO-
t P1. Illest
Applicant Fill / 03 �L
Inside Heavy Lines J013 ADDRESS
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SIDE YARD S =11ACK STREP;T SETBACK REAR YARD SETBACK
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R. 6-2482 HEIGHT I BUILDING AREA VARIANCE NUMBER
GLEN DALE CONSMUMON CO.
ADDRESS
23728 91st P1. � jest
CITY TELEPHONE NUMBER
Ed-monds. Wash. PR 6-2482
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RESIDENTIAL
GAS
El LINE
F0NEW
NON-RESIDENT IAL
SIGN
0 ADD
RETAINING
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
FENCE
( .......... x .......... Ft.)
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
I NUMBER OF
0-1119le
DWELLING
UNITS
Fwi�ly
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
[] YES
Plan Check No ............
a2i
BUILDING
PLITNIBING
HEAT & GAS LINE
PENCE
t SIGN
RETAINING WALL
SWIM NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTALLA31OUNT 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 laws regu-
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicaid Subject to Plan Check Fee
1�wa -Perodt covers work to be done on private property ONLY.
Any construction on the public domain (curbe, sidewalks, driveways,
marquees, etc.) will require separate permission.
AT=NTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
DEFICIENCY THIS PROPERTY
[3 YES [3 NO
Fee
co
vt)
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Owl
I
Receipt No.
117 V. r/.�) I QOSID,
APPLICATION APPROVAL
This application is not a pernilt 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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