680523.pdfWI&Iwlnv ApplicAint FM
PERMIT APPLICATION Indde Iffeavy unes
.41.211 3R OF DU
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ILTY NE NUMB !�910
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MZ1 EPHONE NUM
IDV%jj I K , Z610
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KRESIDENTIA
0
GAS
LINE
ro'I
NON -RESIDE TIAL
SIGN
D
0
DEMOLISH
FJ
RETAINING
WALL
E]
ALTER
EXCAVATE
OR FILL
El
PENCE
Ft.)
11
PRE -MOVE
. ........
swim
REPAIR
rNSP.
Poor,
IUMBIER OF STORIES
NUMRMR or
DWELLING
UNITS
4ATURE OF WORK TO BE D ONE
(01" / ift 0 1 M A i � y
, L
P NOA PERMIT
24UMBIM 680523
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07C-K— I STREET SET]BACK IWAR YARD SET]
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13 Y33
EXISTING -STREET R/W .... ..... XT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W .......... FT. ...... -FT.
[] YES 13 NO
Plan Check No ............
PROPOSED UBE
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BUILDING
20
PLOT PLAN (Indicate Building setbacks, abutting street*)
PLUM33ING
BEAT & GAS LINE
FENCE
t
SIGN
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 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
ATTMMON
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relaung to workman's Compensation Insurance.
AUTHORIZM
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shoal be completed In ninety days; OVED-IN RUELMINGS shoal be oDm.
,e)tln sixympnials.)
C7A%M( INSPECTION
<14;IrAGENTJ ATErNED
, 7VI
f DEPARTMENT
Df
CITY OF
EDMONDS
OTE.: tttfilant Subject to Plan geeck I(ee PR 6-1107
_1&s ]permit coven work to be done an PrlvMf property ONLY.
Amy construction an the public domain (curbs, sidewalks, driveways,
marquees, ate.) will require separate permission.
00
13 YES 13 NO
Fee
.5
APPLICATION APPROVAL
TWs application is not a pernUt until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
J
4