680360.pdfg
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BUILDING DEPARTMENT
PERMIT APPLICATION
or
Applicant Fill
Inside Heavy Lines
4/o/
NOW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
SIGN
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
PENCE
OR FILL
( Ft.)
PRE -MOVE
........ . x .........
sMM
REPAIR
F
INSP.
F-1
POOL
DWELLING
UNITS
I hereby acknowledge that I have read this application; that the in.
formation given In 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-
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
relating to Workman-s Compensation Insurance.
NOTE: Permit Limit One Year (Except DE51OLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private provertr ONLY.
Any construction on the Public domain (curbs, sidevndksp drlvewaysp
marquees, etc.) will require separate permlsslon.
.9 Ll Q.,
k.,
PERMIT
680360
NUMBER
EET SETBACK
REAR YARD SETBACK
'AREA
VACANT SITE
E3 YES 13 NO
LDING AREA
VARIANCE NUMBER
EXISTING STREET R/W .......... FT. DEFICIENCY THIS PROPERTY
140i0awteR
(3, YES 13 NO
[] YES [3 NO
Fee
Plan Check No ........
"IWANIKIC
PLUNMNG
NO.
HEAT A GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
OLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
U 0 C)A-V I �r .3 1
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES
ONLY TILE signed by the Building Official or his Dep-
WORK NOTED uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION
DEPARTMENT
C11TY OF
EDMONDS
PR 6-1107
.1
FILE
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