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BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
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NAME
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Applicant IM11
Inside Heavy Lines
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TELEPHONE NUMBER
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CITY LICENSE NUMBER
Below or Attach Four Copies)
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NEW
RESIDENTIAL
GAB
LINE
NON-RESIDENTIALJ
SIGN
DEMOLISH
RETAINING
WALL
ALTER
EXCAVATE
OR FILL
FENCE
( x Ft.)
REPAIR
PRE -MOVE
INSP.
......... . ........
SWIM
POOL_
IUKHER or STORIES
NUMBER OF
DWELLING
UNITS
TN KROLL MAP NO.:
NUMBER
PERMIT
LRD SETBACK I STREET SlYrASAUK
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680354'-
A/0 ��A
EAR YARD SETBACK
0
ACA.NT SITE
(YES C] NO
ll!A�';;REErr R/W ..5�2FT. DEFICIENCY THIS PROPERTY
EXISTING
COMP. PLAN ST. R/W Fr.
REMARKS
Driveway slopes not to exceed those
tn9icared on standard Drawine #Iu3.
[3 YES
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Plan Check
PROPOSED UBE
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BUILDING
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PLUMBING
PLOT PLAN (Indicate Building Setbacks, abutting streets)
BEAT & GAS LINE
I
10
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin 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 lawn rigui-
luting construction; and in doing the work authorized thereby, no person
ATTENTION
will be employed In violation Of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen'm Compenwitlon Insurance.
AUTHORIZER
NOTE: Permit Umit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shoal lie completed in ninety days: MOVED -IN ]BUILDINGS shall be com-
plated in mix months.)
INSPECTION
DEPARTMENT
IIGNA URE (OWNER OR AGENT)
7
DATE SIGNED
K0,
of
CITY OF
EDMONDS
NOTE: Applicant Subject lo Plan Check Fee
PR 6-1107
This Permit eavers work to be done an Priv"e property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, de.) wR1 require seParate Pormnisslon.
4(
10 YES E3 NO
No.
1 /338 14
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APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
FILE
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