680274.pdfIf: ...............
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OIL NAME OF IJUSINESS,
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CITY TELEPHONE NUMBUR
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NAME
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STATE LICENSE NUMBER C
Legal Description of Property (Show Below or
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POSTED ON KROLL MAP NO.: PERMIT
NUMBER 680274
JOB ADDRESS
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SIDE YARD SETHJALCK
STREET SETBACK REAR YARD SETBACK
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525'02.��
'U05T AREA
VACMil SITE
USE N9;_1
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[] YES
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ARMA I VARIA
RESIDENTIAL
GAS
LINE
FINEW
ME]
NON-RESIDENTIJAL
SIGN
ADD
RETAINING
[_�
WALL
DEMOLISH
ALTER
M
EXCAVATE
OR FILL
PENCE
( .......... x ......... Irt.)
E] REPAIR
M
PRE -MOVE
INSP.
SWIM
POOL
IUMBER OF STORIES
-NUMBER OF
DWELLING
UNITS
EXISTING STREET R/W ............ M- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT- . ............ FT.
[3 YES
TYPE
0 �j
Plan Check No ............. .......
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
33
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMBUNG 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 cw�ner, or the duly author-
ized a9vat 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 PERNUT
relating to Workmen's Compensation Insurance.
AUTIIOR1ZM
ONLY THE
NOTE: Permit Limit One Year (Except DE51OLITIONS which
WORK NOTED
shall be completed In ninety days; MOVED -]IN BUILDINGS shall be com.
plated In mix months.)
SIONAT R OA AGENT)
DATE SIGNED
INSPECTION
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DEPARTMENT
4
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permfl covers work to be done on Private property ONLY -
Any construction on the public domain (curbs, sidewalks, driveways,
marquess, etc.) will r0quire separate Permission'
V_
Valuation
0 YES [3 I -to
Fee
No.
APPLICATION APPROVAL �1 1
This application is not a permit Un
Signed by the Building Official or his Detp-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
FILE
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