680102.pdf�11 POSTED ON
BUILDING DEPARTMENT Applicant FlU
Inside Heavy Lines JOB ADDRE
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Ilk" PERMIT APPLICATI N
NAME (OR NAME OF BUSINESS)
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MAILING A.DDRESS
CITY TELEPHONE NUMBER
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NAME
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CITY TELEPHONE NUMBER
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or
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PERMIT e.'�
NUMBER 680104:_
1D SETBACK STREET SETBACK REAR YARD SETBACK
'rV\ t.-Vi 7)`74�j /77.4� 0
IE LOT AREA VACANT SITE
�� '�A 13 YES [3 NO
I BUILDING AREA I VARIANCE NUMBER IN
EXISTING STREET R/W
COMP. PLAN ST. R/W
FIRE
Pe
RESIDENTIAL
GAS E] YES Ej NO
LINE
ETNEW
PLAN CHECKED BY
ADD
NON-RESIDENTIA1.
SIGN
REMARK13
RETAINING
WALL
DEMOLISH
EXCAVATE
FENCE
I
ALTER
OR FILL
( ......... X .......... Ft.)
REPAIR
PRE -MOVE
INSP.
swim
POOL
IUMBER OF STORIES
NUMBER Or
DWELLING
UNITS
Plan Check No ............ . .......
PROPOSED USE
'r
BUILDING
PLOT PLAN (Indicate Building setbacks, a Ing streets)
PLUMBING
HEAT & GAS LINE
FENCE
CP 48
SIGN
RETA.INING 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 laws regu-
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 Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com-
pleted in six m"W"ba.)
UGNATU 0 DATE SIGRL�D
INSPECTION
DEPARTMENT
6
CITY OF
EDMONDS
NOTZ Applicant S'ubject to Plan Check Fee
PH 6-1107
This Permit coven work to be done on private property ONLY.
&ny congtraction on the pubtle domain (carbs, sidewalks, driverways,
rawquees, etc.) will require separate permission.
DEFICIENCY THIS PROPERTY
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Valuation
0
L
r'irI
(:] YES 13 NO
Fee
No.
B
"t FEW.
APPLICATION APPROVAL
This application is not a perimit until
signed by tile Building Official or Ms Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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