690213.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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Legal Description of Property (Show
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NEW Li . RESIDENTIAL LINE
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Lim . NON-RESIDENT
ADD F SIGN
RETAINING
DEMOLISH WALL
ElALTER EXCAVATE FENCE
OR FILL ( ........ . x .......... Ft.)
PRE -MOVE swim
REPAIR El INSP. —R—UMBER OF POOL
DWELLING
UNITS
PERMIT
NUMBER 690213
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USE ZONE
LOTU�'
VACANT SITE
YES
BUILDING AREA
VARIANCE NUMBER
PLOT PLAN APPROVEM
STREET R4f3y
EXISTING STREErr R/W .... ....... FT.
DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ........... FT.
............ PT.
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REMARKS
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Plan Check No ................ ...
BUILDING
ED USE 4) —
LAN (Indicate Building setbacks abutting streets) BEAT & GAS LINE
6 PENCE
SIGN
*Of t RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
17 1 EXCAVATION OR FILL
TOTAL A31OUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given In 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
TH118 PERMIT
I
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
Pleted In mix months.)
1IGNA&CVLE (OWNER OrE�_
LDATE 8 ON D
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check- Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivew"s,
marquees. etc.) will r6quire separate permission.
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Valuation Fee
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APPLICATION APPROVAL
This application Is not a pernift until
eigned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac.
lmowledged in space provided.
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