680343.pdfBUILDING DEPARTMENT I Applicant 011
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ILL MAP NO.: PERMIT A -%
NUMBER 68034%5
ISIDE YARD SETBACK STREET BETBACK ltlujut X�%�
USE ZONE LOT AREA VACANT SITE
(2 1[3 YES &0
I BUILDING AREA --FV—AIUANCE NUMBER a,
NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
I
SIGN
ADD
RETAINING
DEMOLISH
WALL
ElALTER
EXCAVATE
FENCE
OR FILL
( x Ft.)
REPAIR
PRE -MOVE
INSP.
........ . . ........
Emu
POOL
NUMBER OF
DWELLING
UNITS
El
I'
EXISTING STREET R/W .......... XT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W .... ...... FT.
FIRE ZONE I TYPE
[J YES [] NO
I'lan Check
PROPOSED USIB
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby Atknowledge that I have read this application; that the In-
formation given fs 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 -a Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
letpd-1 six months.)
i Q�11
:1 CFN—AT U)E/�577/7
-
DATE SIGNED
I NSPECTION
I N I
rlrT)
1-Y .4..- r. -
DEPARTMENT
-& 0
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
nuLrquots, otc.) will require separate 118rallsolm.
CITY OF
EDMONDS
Pn 6-1107
0 YES [:] NO
Valuation I Fee
M
I
to
No.
I '?, '0 in vd'se-v
APPLICATION APPROVAL
This application is not a pernilt until
signed by Uie Building Official or Ms Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
FILE
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