690075.pdfBUILDING DEPARTMENT
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PERMIT APPLICATION
(OR 14AXE OF ausumse)
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EN38TING STREET R/W ............ FT -
COUP. PLAN ST. R/W ........... FT.
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037
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F%71 RESIDENTIAL
Lai
GAS [J YES C3 NO
LINE PLAN CHECKED BY
NEW
11 NON_R
1=
SIGN
In
1:1
RETAINING REMARKS
WALL
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DEMOLISH
ALTER
EXCAVATE
FENCE
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OR FILL .
( ........ .
REPAIR
PFXMOVE
INSP.
Effirim
POOL
PERMIT 69OU-10
NUMBER
TBAC19 REAR YARD SETBACK
VAU"K RLA�
C3 YES KNO
AWWA T-VARUNCIC NUMBER
DEFICIENCY THIS PROPERTY
13 YES 13 ITO
DWELLING
UNITS
NATURE OF WORK TO BE DONE
New
Valuation Fee-
rian Check No ............. . ....
PROPOSED UBE 71- X I 7cil
t, J/ I've- )20a>
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
BEAT & GAS LINE
FENCE
t
SIGN
66
RETAnaNG WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the in-
n
formation given is correct; and that I am the owcer, or the dUlY allthOr-
,zed agent of the owner. I agree to comply with city and state laws rsgu-
ATTEI'MON
APPLICATION APPROVAL
laung construction; and In doing the work authorized thereby, no person
of the Labor Code of the State of Washington
THIS PERMIT
This application is not a perntit until
will be employed in violation
relating to WorkineWs CompeOW101 Insurance-
AUTHORIZES
Signed by the Building Official or his Dep-
NOTE: Permit Limit One YOur (Except DEMOLITIONS Which
ONLY TIRE
WORK NOTED
uty; and fees are paid, and receipt is ac-
#hall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
plated In Nix months-)
SIGNATURE (OWNER T) DATE SIGNED
INSPECTION
1.3 -/V � 4
DEPARTMENT
-
CITY OF
' _" W Fee
EDMONDS
DAT
5L (0
NOTYApplicant Subject to P Ian Cbeck
'
PR 6-1107
This Permit covers work to DO GODO an Pr'"" property ONLY'
domain (curbs, sidewalks, driveways,
Any construction on the public
marquees, do.) will require separate permission.
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