690014.pdf001101
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PAAIPW.n nN ICRnT.T. MAP NO�! PERMIT
Lp_BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Ileavy Lines
NAME (OR NAME OF BUSINESS)
, A I C"A I I I
17A
!V! a of Property (Show Below or Attach Four Copies)
E
NEW RESIDENTIAL
GAS
LINE
ENTI
NON -REBID AL
0
SIGN
ADD
RETAINING
DEMOLISH
WALL
NALTER
r
EXCAVATE
FENCE
OR FILL
( X F'.)
REPAIR
PRE -MOVE
INSP.
.......... ..........
swim
POOL
DWELLING
UNITS
OF WORK TO BE DONE
0 A n .
740771A-
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-
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 DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
/_ /_C__ 46
NOTE: Applica-ni Subject to Plait Cbeck Fee
This Permit covers work to be done on private property ONLY.
Amy construction on the public domain (curbs, sidewalks, driveways,
marquees* etc,) will require separate permission,
%DDRESS
,,YARD BETB!LCK 81
I "
1�
INUMBER bi�JUU 1 14
V.)
V SETBACK
REAR YARD SETBACK
r), �j
STREET B1W
EXISTING STREET R/W ....... .... FT.
COMP. PLAN ST. R/W ............ IT.
RMMARKH
R SIZE I 13ERVJ
VACANI
[3 YES No
AREA VARIANCE NUMBER 0.
DEFICIENCY THIS PROPERTY
....... .... I
14
z
N
CHECKED BY
RANCE
CHECKED BY
VERIFIED BY
PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
[] YES 13 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES NO
PLAN CHECKED BY
Valuation
Plan Check No .....................
No.
BUILDING
PLUMBING
tov
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TILE
WORK NOTMD
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
APPLICATION APPROVAL
This application is not a perlinit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
FILE
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