690085.pdfBUIOING DEPARTMENT
PERMIT APPLICATIKON
B
kit
8
Applicant Fill
Trialfie Heavy Lines
PERMIT
NUMBER
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SIDE YARD SETBA
bTjS19Xrr MAJW"^W�
REAR YARD SETBACK
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/
USE ZONE
LOT AREA
VACJA NT SITE
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13 TES eqfo_,�'
NEW
RESIDENTIAL
I
GAS
LINZ
NON-RESIDENTLAOLL
SIGN
�rADD
DEMOLISH
RETAIMNG
WALL
E] ALTER
EXCAVATE
OR FELL
PENCE
Ft.)
. ........
El REPAIR
PRE -MOVE
INSP.
swim
POOL
ES
NUMBER OF
DWELLING
UNITS
i —f —"-
iR 9G STREET R/W .......... XT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... Irr.
[3 YES [3 NO
Plan Check No ........
BUILDING
PLUMBING
BEAT & GAS LINE
FENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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.
ATTENTION
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
THISPERMT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUHMINGS shall be oom-
plateV six Months.)
a 'co � '
FIGj�l 11- _'�A GENT)
1IG AT RZE _(OWNE 000��
77
DATE; SIGNED
INSPECTION
DEPARTMENT
A.;U- _1�1— - 1_1�� i IF CITY OF
NOTE: ApplicanfSubject to Plan Check Fee EDMONDS
PR 11-1107
This Permit coven work to be done an private property ONLY.
Any construction on the public domain (carbs, sidewalks, driveways,
marquees, ate.) will require separate permission.
[] YES El NO
Fee
APPLICATION APPROVAL
I
91
No.
This application is not a permit until
signed by the Building Official or Me Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
8
.1