690115.pdfPERMIT APPLULAUUM I Inslac Heavy ""s
NAME (OR NAME OF BUSINESS)
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CITY ELEPHONE NUMBER
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NAME
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ADDRESS
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TELEPHONE NUMBER
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NAME
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CITY TELEPHONE NUMBER
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FT —ATE LICENSE NUMBER cri-r I.AuENSE NUMBER
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PERMIT
NUMBER A90
1
5
7RE—ETSETBACIC.
REAR YARD 13ETBACK
Y,
OT AREA
VACANT 131TE
YES
N(NO
Z
EXXSTING'STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. RIW ........... I". ............
REMARKS
_'11 CHECKED BY
asai Description or Property (tinow mciow or %tutca. vour uupiu-p
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APL�E Uj C)-&t) TYPE
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NEW
ALTER
REPAIR
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jf�j RESIDENTIAL El
ElNON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
INSP. El
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( .......... x .......... Ft.)
SWIM
POOL
ES
NUMBEIC or
DWELLING
UNITS
(�) Q E_
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C) n
PROPOSED USE
PLOT PLAN (Indicate Building setbacks, abutting streets)
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I hereby acknowlerigo that I have read this application; that rho In-
formation given in correct; and that I am the owner, or the duly author-
lzed 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 Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED-XN BUILDINGS shall be cont-
plettd_&p.six months.) I
34"ATURE (2WNE A T) DATE SIGNED
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----��NOTE: Applicant Subject to Plan Cbeck Fee
This permit covers work to be done on private Property ONLY.
Any construction an the public domain (ewba, sidewalks, driveways,
ntarquees, etc.) will require separate perrnftslon.
I
0 YES
rian Check No
BUILDING
PLUMRING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMWNG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
�TOTAL AMOUNT DUE
ATMNTION
Tfus rEnBUT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
rR 6-1107
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Valuation
[] YES d No
Fee
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Recolpt No.
I'Al. 0 1
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.
F71M lle�$ � ,
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Fire Dept.