690179.pdfBUILDING DEPARTMENT Applicarlt Fill
PERMIT APPLICATION I Inside Heavy Lines
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PERMIT
NUMBER 690179
9U 0 / :?l -I - � f W9
YARD SETBACK STREET SETBACK REA." XAUU b2i CK
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3 E LOT AREA VKU
1 2�_ 1 [] YES 0
UILDING AREA. I VARIANCE ZIUMBER
EX6116ING-STREET R/w ........... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... X-r. .......... ITT. 0
REAU-RKB
OK to connect into sanitary sewers but with
No larger line than 2".
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NEW
RESIDENTIAL
R
GAS
LINE
NON-RESIDENTIA.L
D
SIGN
RETAINING
DDEMOLISH
WALL
ALTER
D
EXCAVATE
OR FILL
FENCE
( X Ft.)
........ . ..........
REPAIR
PRE -MOVE
INSP.
swim
POOL
rumBER OF STORIES I NUMBER OF
DWELLING
UNITS
0 YES [] NO
rian Check No ..................
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
BEAT E
FENCE
;3
t
SIGN
-5
N
1 lo It
I
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-
format.lon given to 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
THIs rER5111T
relating to Workmen's Compensation Insurance.
AUTIIORIZES
ONLY TILE
NOTE: Permit Limit One Yetcr (Except DEMOLITIONS which
WORIE NOTED
shall be completed In ninety days; AIOVED-IN BUILDINGS sWI be com-
Plated In nix months.)
&ZIGNATURE
(OWNN;kt
I DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done on Private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marque,as, age.) win require separate permission.
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[3 -me [I No
Fee
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APPLICATION APPROVAL
No.
This application Is not a pernilt until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
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