680131.pdfI
BUILDING DEPARTMENT, I Applicant FlU
PERMIT APPLICATION Inside Heavy Lines
I
4
V
;42 3 o I � (9 07 4-
1
.
Legal Description of Property (Show low or
<:�� -V T
W Ail Aim 38:t
NEW RESIDENTIAL
NON-RESIDENTL&L
C&DEMOLISH
ALTER EXCAVATE
FI OR FILL
REPAIR PRE -MOVE
D INSP.
DWELLING
UNITS
Z
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( ........ x� ........ Ft.)
swim
F-1
POOL
LL MAP No.: PERMIT
I NUMBER
d
0 -V�
. & CA-
0K REAR YARD SETB
VACANT SITE)
13 YES 13 NO
EXISTING -STREET R/W ......... FT. DEFICIEVCY TMS PROPERTY
COUP. PLAN ST. R/W ........... 1". .. ....... FT.
[] YES [:] NO
Plan Check No ... . .....
BUILDING
PLUMBING
HEAT & GAS LINE
t
FENCE
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 owns r. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorized thereby, no person
V wlill be employed In violation of the Labor Code of the State of Washington
V
totaling to Workmea'a Compensation Insurance.
NOTE: Permit Umit One Year (Except DEMOLITIONS which
ball be completed in ninety days; MOVED -IN BUILDINGS shall be Lom.
[SZ111'eted in six tripallia.1
4/_/_406
NOTE: Applicant Subject to Plan Check Fee
This ]Permit cOven work to be done on private property ONLY.
Any construction an the public domain .(CUrba, sidewalks, drIvewayss
marquess, etc.) will require separate permission.
13 YES
[3 NO
R
ATTENTION APPLICATION APPROVAL
T1118 PERMIT This application Is not a permit until
AUTHORIZES
ONLY THE signed by the Building Official or his Dep-
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS DATE L*
PH 6-1107
FILE 1�
j,�C
4
4 1 1