680309.pdfI
rBUILDING DEPARTMENT
"PERMT APPLICATION
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ADDRESS
4///7
Applicant MR
Inside Heavy Unes
4Z,2-
NEW
RESIDENTIAL
I
n
GAS
LINE
ADD
NON-RESIDENTL4,L
jZ
SIGN
RETAINING
0
DEMOLISH
WALL
0
EXCAVATE
PENCE
ALTER
OR FILL
( x Ft.)
D REPAIR
PRE -MOVE
INSP.
........ . . ........
SWIM
POOL
NUMBER OF
DWELLING
UNITS
C
PERMIT
NUMBER
;' I a
b '80309
-d�
5� e5r"Z'-f_
SIDE YARD SETBACK STREET SETBACK REAR T D
USE
jgNE LOT AREA VAV�& QEKM
13 YES 13 NO
ING A-REA I VARL&NO19 NUMBER
KrBTING'STREET n/w DEMCIENCy THIS PROPERTr
COMP. PLAN ST. R/W .. ....... FT.
[j YES 0 NO
Z
Plan Check No ..................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
IQ
BEAT & GAS LINE
FENCE
tSIGN
F_
RETAINING WALL
SWIIUUNG POOL
DEKOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby &nitnowledge 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 Workmenlo Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
aball be completed In ninety days; MOVED -IN BUILDINGS shall be oom.
pleted In six months.)
A NT) DATE SIONE
SIGNATURE (OWNER D
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This nit coven work to be done an private property ONLY.
Any construction an the public domain (earbs, sidewalks, drlv&w&75,
marquess, ote.) wW require separate permission.
Valuation
00
E3 7ES 13 NO
Fee
No.
1 5, 0 0 k4s-a t
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his D813-
uty; and fees are paid, and receipt is ac-
Itnowledged in space provided.
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