680527.pdf:.BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside 11siavy Lines
MAKE (Olt NAILM 00 BUSINESS)
6AItz. iz.5 s-"A
E-3
S
NEW
E] ADD
ALTER
REPAIR
El
RESXDENTL4,L
NON-RESMENTIAL
DEMOLISH
EXCAVATE
OR FILT
PRE-MOVIC
INSP.
El
GAS
LINE
SIGN
RETAINING
WALL
Fz
2V
(ki XJ.P.A.Ft.)
SWIM
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
HATUR331 OF WORK TO BE DONE
I hereby acknowledge that I have read this applicstion; that the in.
formation given Is correct; and that I am the owner, or the duly author-
lzed 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 Insumce.
NOTE: Permit Limit One Your (Except DEMOLITIONS which
@hall be completed in uluety days; MOVED -IN BUILDINGS shall be oorn-
plated In tlx months.)
XQTE: Appli"nt Subject to Plan Check Fee
This Permit coven Work to be done on private property ONLY.
Any conskoction an the public domain (curbs, sidawalki, driveways,
marquees, etc.) will require separate permission.
C
LL MAP NO.:
NUMBER
680527
CPU
C SETBACK YARD 8
LOT AREA VACANT SM
%� 1 13 YES )4NO
E=TING STREET R/W
COMP. PLAN ST. R/W ........ .. XT.
[] YES 13 NO
Plan Check No...
DEFICIENCY THIS PROPERTY
YES E3 NO
Valuation I Fee
BtnLDING
PLUMBING
BEAT & GAS LINE
PENCE
SIGN
t—c'_
RETAINING WALL
SWIMMING POOL
DEMOLMON
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOT" AMOUNT DUE
ArZENTION
TM8 PERMIT
AUTHORIZER
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CM OF
EDMONDS
PR 6-1107
APPLICATION APPROVAL L--,o
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.
O'N
I
HLUUKU Ull
10.1
Date Passe