690153.pdf... .......
BUILDING DEPARTMENT
PERMIT APPLICATION
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CITY
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Applicant FM
Inside Heavy Lines
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RESIDENTU
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GAS
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NEW
NON -RESIDE NTIAL
r_J
SIGN
RETAINING
ElDEMOLISH
F1
WALL
ALTER
EXCAVATE
FENCE
on PILL
( ........ . x .......... Ft.)
REPAIR
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PRE -MOVE
INSP.
El
SWIM
POOL
-
NUMBER OF
DWELLING
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UNITS
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.... ......
:ROL.L It" NO.:
PERMIT
I NUMBER
690153
17 d
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3ETBACK
STREET SETBAC
ARD SETBACK
y
LOT A11EA
VAUA—NTSITE
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0 YES No
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AnEA
�AnT�Wn— KUMBER
EXISTING STREET R/W .......... FT.
COMP, PLAN ST. R/W ........... XT.
[] YES
13 NO
Plan Check No ..................
PROPOSED USE
BUILDING
GaI-aAc CAVIA _40%-a4e,
PLOT PLAN_XIndIc&to Building setbaclus, abutting streets)
PLUMBING
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 have read thin 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-
ATTENT]ION
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 PERMIT
relating to Workman's Compensation Insurance.
AUTHOREZES
ONLY THE
NOTE: Permit Limit One Year (Except DE5101JTIONS which
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
13IGNKT-URE (OWNER OR AGENT) DATE SIGNED
INSPECTION
Lt ._,� L) - 6,q
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
rIt 6-1107
This permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
numquess, etc.) will require separate permission.
DEFICIENCY THIS PROPERTY
Valuation
BY
0 YES 0 NO
No.
W3 M400 rZOARM
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or Ws Dep-
uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
LL-__
FEE
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