690174.pdfC.
_NT AppUc:ant Fille =a POSTED Oi
BUILDING DEPARTMENT
U"
MI CATION Inside H vy ]fte:o
RMIT APPLI O:i I Joe A_DDR
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a
10 RESIDENTIAL
AS
281101:
NEW
0
N
1 11
NON-RESIDENTIAIJ
F-1
19 AWIJ
RETAINING
WAIZ
DEMOLISH
D ALTER
EXCAVATE
OR FILL
PENCE
( ........ . X ......... rt.)
REPAIR
P
INRSEiMOVZ
F1
SWIM
POOL
Es
NUMMin Um -
DWELLING
UNITS
MAP NO.: I PERMIT b7U 1
ER.
LOT A [Vi�XdANT SIWJ9
'4T "IT!
S V No
Jim
11 YES 13 NO
VARIANCE NNUMBEn
BUILDING AREA
A PR ED
a C 4 0.
FICIENCY, THIS PROPERTY
I STREET R/W .... ....... FT- �/E
PLAN ST. R/W .... ...... ............ 11T. 0
SIZE 13ERVICE SIZE CLEARANCE CHECKED 33
TYPE
[] YES [3 NO
Pion Check No ........
BUILDING
PLOT PLAN (ladle III: il 1! 1 Ill streets) PLUMBING
HEAT & GAS LINE
FENCE
tSIGN
RETAINING WALL
SWIMMING POOL
N
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application: that the In-
formation given to correct; and that I am the owner, or the duly author-
tzed agent of the owner. I agree to comply with city and state law" rcgu- 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 THIS PERMIT
AUTHORIZES
relating to Workmen's Compensation Insurence- ONLY THE
NOTE: Permit Limit One Year (Except DE51OLITIONS which WORK NOTED
shall be completed in ninety days; JkJOVED-IN BUILDINGS shall be com-
pleted In six months.) INSPECTION
IATURE (OWNER OR AGENT) "ALM SIGNED
DEPARTMENT
CITY OF
EDMONDS
NOTE: ApPlicant Subject to Plait Check Fee PR (1-1107
This P t covers work to be done on private Property ONLY.
Any cons ructlon on the public donWn (ewbs, sulawalkip drivewayet
ocarqUeep, Cie.) will require separate P0rnds1J0"-
[] YES EJ NO
Valuation I Fee
I _1�1 on 1U7,11:
APPLICATION APPROVAL
This application is not a permit until
signed by the Building official or Ws Dep-
uty; and f ees are paid, and receipt Is ac-
Imowledged in space provided.
9