690040.pdfRE 88
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ADDRESS
RESIDENTIAL
GAS
LINE
ElNEW
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NON-RESIDENTIAL
SIGN
ADD
RETAINING
WAIJ
ElALTER
DEMOLISH
EXCAVATE
PENCE
OR FILL
( X Ft.)
REPAIR
E]
PRE -MOVE
INSP.
.......... ..........
swim
POOL_
FUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
a, MAP NO..,
PERMIT
NUMBER 69,0040
lACK I STREET SETBACK rRkAR, YARD SETBACK
E] YES 13 NO
EN38TING . STREET R/W .--FT. DEFICIENCY THIS PROPERTY
FIRE ZOND I TYPE
Cj YES [3 NO
[] YES 13 NO
Valuation I Fee I Receipt No.
Plan Check No ..................
PROP013ED USE
BUILDING
U
0
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
al
0
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 hava 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
THIS PE101IT
This application is not a permit until
relating to Workman's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
Imowledged in space provided.
pleted In six months.)
Olt
SIGNAT RE ER. OW AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
�11IQN
CITY OF
EDMONDS
-IVOTE: Applicant Sitbject to Plan Check Fee
Pit 6.1107
-9-
This Permit covers work to be done on private Property ONLY.
Any construction on the public dornsic (curbs, sidewalks, driveways.
FILE
marquees, etc.) will require separate permission.