690063.pdfr
BUILDING DEPARTMENT
PERMIT APPLICATION
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CITY
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ADDRESS
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CITY
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POSTED ON KROLL MAP NO.:
Applicant M
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Inside Heavy Lines JOB ADDRESS
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a Description of Property (Show Below or A
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60
2
RESIDENTIAL
GAS
LINE
NEW
ADD
NON-RESIDENTI.AL
SIGN
RETAINING
DDEMOLISH
WALL
EXCAVATE
FENCE
ALTER
M OR FILL
Ft.)
REPAIR
PRE -MOVE
F1 INSP.
0
..........
swim
POOL
rUMBER OF STORIES
NUMM.'It OF
DWELLING
UNITS
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
will be employed In violation of the Labor Coda of the State of Washington
relating to WorkmeWs Compensation Insurance.
NOTE: Permit Limit One Year (Except DE510111TIONS which
shall be completed in ninety days; MOVED -IN BUILDINCS shall be com.
pleted in six months.)
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NOTE: Applicant Subject to Plat; Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curb@, sidewalks. driveways,
marquees, etc.) will require separate PermInloal.
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Z NE
I LO ARE
PERMIT
NUMBER 690063
ETBACK MAR YARD SETBACK
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g-S 13 NO
AREA I- VARIANCE NU� N
EXIdfiNG'STREMT R1W .... . .... FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W
REMARKS
Driveway slopes not to exceed those
indicated on Standard Drawing #103.
I
I _Jr_� 113 YES 0 NO
SPECIAL INSPECTOR REQUIRED OCYCY GROUP
0 YES ')<NO 1
Plan Check No ........
BUILDING
PLUMBING
HEAT
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THISPERMT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
Valuation Fee
/9
No.
1/0 (Oclo V041
APPLICATION APPROVAL
This application is not a permit until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
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