680435.pdfA
BUILDING DEPARTMENT Applicant 011
inside Heavy Lines
PERMIT APPLICATION I -
CITY
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NAME
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CITY
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Below or ALIAM Pour uoymni
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RESIDENT
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LINE
NEW
1:1 =NON-REBIDENTL4.L
SIGN
AVV
DEMOLISH
RETAINING
WALL
ALTER EXCAVATE
OR FILL
FENCEj ... Ft.)
(/,K/.x .....
PRE MOVE
REPAIR INS;.
swim
POOL
z
DWELLING
UNITS
RATURE OF WORK TO 13E DONE
NU . USER bbU400,
REAR YARD 8
)E YARD SETBAUkL STREET 8 MACK
3E ZONE AREA VACANT SrJ:E
[3 YES
I ST?.EET R/W ............ FT- DEFICIENCY THIS PROPERTY
PLAN ST. R/W ............ Fr. ........... FT.
FIRE ZONE TYPE OF CONI
[3 YES
A
PROPOSED USE
Mn Check No .....................
BUILDING '&r'7037-0
abutting streets)
PLUMBING
14
0
HEAT & GAS LINE
PENCE
t
SIGN
u EA�—1 0
3c'�;l
. - \
RETAINING WALL
0 lete
SWIMMING POOL
+
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby mcknowiedge that I have read this application: that the In-
formation given In correct; and that I am the owner, or the duly author-
tzed 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 U's State of Washington
THIS PERSIXT
relating to Workmela's Compensation Insurance.
AUTFIOIUZES
ONLY TIM
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In nix months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
7
CITY OF
EDMONDS
NOTE: APPlicaut Subject to Plan Check Fee
Fn 0-1107
_ii�, rennit covers work to be dons on private property va�x-
Any construction on the public domain (carbs, sidewalks, drIverwaYs.
marquees, etc.) will require separate permission.
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14
[] YES
roe I Receipt No.
I I d__&_04�—C2 [1,4es-L-9
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-
Imowledged in space provided.
I
FILE
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