680066.pdfC
UILDING DEPARTMENT AppilcantIM
PERMIT APPLICATION inside Heavy Unes
Property (OnOW MIDW Or AUMB Z1
7' 2'h
C
LOLL MAP NOA PERMI
NUMBER 6800
AX_ d
_
a V - 9'3
UBE ZONE LOT AREA VACANT SITE
I 1 13 TER 13 NO
I_U_.Tnu� VARIANCE NUMBER
EXISTING I STREET R/W DEnCrENCY TH113 PROPERTY
COMP. PLAN ST. R/W ............ FT. ... ........ 1". —
NEW
ADD
ALTER
REPAIR
El RESIDENTIAL
NON-RESIDENTIAL
E11—
@ DEMOLISH
EXCAVATE
E] OR FILL
I PRE -MOVE
El INSP.
El
E]
El
GAS
LINE
BIG,,
RETAINING
WALL
PENCE
( ......... x .......... Vt.)
SWIM
POOL
13 YES [3 NO
PLAN CHECKED BY
REMARES
I
IUMBER OF STORIES
AV
Rujazzil CP
DWELLING
UNITS
I
Plan Check No ................
PROPOSED USE
/;/L6_'
BUILDING
M
A1:0
_PL& PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
CA
HEAT & GAS LINE
PENCE
t SIGN
N
RETAINING WALL
SWIM NO POOL
OL]TION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In-
fortuatton 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 rega- ATTENTION
latinc construction; 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
relating to Workinsulp Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit Oita Your (Except DEMOLITIONS which WORK NOTZD
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
DATE BIG
SIGNATURE (OWNER Oft AGENT) NED
rNBPECTION
j
DEPARTMENT
F -.4
d
CITY OF
Iiii
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
FIR 6.1107
This permit covers work to be done cia private property ONLY.
Any coastruction an the public domain (curbs. sidewalks, driveways,
nuLrquees, ete.) win require separate permission.
Valuation
13 YES t3 NO
I Wa% - Lj L.r 11 -1 — —
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.
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