680077.pdfZ
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WIN
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Applicant FIR
Inside Heavy Lines
Rr.
2T�W
RESIDENTIAL
I [�n
F1
GAS
LJNE
ADD
ALTER
REPAIR
LEINON-RESIDENTIAL
SIGN
RETAINING
WALL
PENCE
.......... Ft.)
swim
POOL
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
1:1 INSP.
El
[UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
I
AP NO.: PERMIT
NUMBER
Trz, 0"Y6-
0 _19�
STREET SETBACK � I BEAR T,
- a S' F 1;5� 1 /Y I
LOT AREA VACANT
1 13 YES
EXISTING STREET R/W ............ FT. DEFICIENCY
COUP. PLAN ST. R/W ............ FT. J
0 YES
I( I '��a it
4-c,� r--
Plan Check No ............. .......
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting street$)
HEAT & GAS LINE
PENCE
_t�F) C_ N
SIGN
RETAINING WALL
SWIMMING POOL
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 lawn rogu.
ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Wanhington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTIIORlZE8
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVEDAN BUILDINGS shall be com-
pleted In nix months.)
UONATU
. It AGENT)
WN C
DATE SIGNED
INSPECTION
DEPARTMENT
;OTE:
CITY OF
EDMONDS
0 JiC t S
APPOcant Subject to Plan Check Fce
PH 6-1107
This Permit coven work to be done on private Property ONLY.
Any construction an the public dormsm (carbso sidewalks, driveways,
nuwquces, etc.) will require sappritte pern4stion.
Valuation
rA
SETBACK
NO
UMBER
PROPERTY
30
E3 YES [3 NO
No.
1 7_0' �` jjq;-fj9
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-
Itnowledged in space provided.
U
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