680490.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUL51N
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MAILANG ADDRESS
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Applicant Fill
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EXISTING STREET R/W ... ........ FT.
COUP. PLAN ST. R/W ............ FT.
ZONE I TYPE OF
]PERMIT
NUMBER 680490
ACK REAR YARD SETBACK
VACALWX U
13 YES 13 No Z
I
I VARIANCE NUMBER
&A—NTSITE
MA
DEFICIENCY THIS PROPERTY
[] YES 13 NO
N
GAS [] YES 0 NO
NEW RESIDENTIAL LINE PLAN CHECKED BY
NON-RESIDENTIAL 0 SIGN
F� AD.) RETAINING REMARKS
DEMOLISH WALL
DALTER EXCAVATE PENCE
El OR FILL ( ........ . x .......... Ft.)
PRE -MOVE swim
REPAIR INSP. POOL
NUMBER OF STORIES NUMBER or
DWELLING
UNITS
NATURE OF WORK TO BE DONIk_
Valuation Fee Receipt No.
V
Plan Check No .....
........ ..
PROPOUND UqF, BUILDING
PLOT PLAN (Indicate Building setbacks, &butting streets) PLIMIMING
HEAT & GAS LINE
FENCE
t SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge 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 APPLICATION APPROVAL
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 Tius PERMIT This application is not a perinit until
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY TIM signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt Is ac-
shall be completed In ulnety days; MOVED -IN BUILDINGS shall be com- Imowledged in space provided.
pleted In six months.)
SIGN U� (OWN117!1:1 �A121EN E SIGNED INSPECTION —DIRECTOWS _11IGNATUM
Lle&— DEPARTMENT - / - �9
Ito ly � -17
I I CITY OF
00 44Z, �,
. Li I EDMONDS A ;, .
NOTE: Applicant Subject to Platt Check Fee PR 6-3207 W
This FermIt covers work to be done en private property ONLY.
Any construction on the public domain (curbs, sidewalka. driveways, FILE
marquees, etc.) will require separate permission.