690227.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICAI Inside Heavy Lines
N",E (on NAME OF BUSINESS)
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STA!YE LICENSE NUMBER Wily L4CEN
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I T�rftl nonerintinn or PrODerty (Show Below or Attach Four
POSTED ON KROLL MAP NO.: PERMIT
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NUMBE qn??7
JOB ADDRESS
SIDE YARD SETBACK STREET �IJETBACK REAR YARD SETBACK
NE LOT AREA VACA
USE ZO SITE
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RESIDENTIAL
El
GAS
LINE
DNEW
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NON-RESIDENTIAL
SIGN
ADD
RETAINING
WALL
ElDEMOLISH
ALTER
F
EXCAVATE
OR FILL
El
FENCE
( .......... x .......... Ft.)
REPAIR
PRE -MOVE
INSP.
swim
POOL
NUMBER OF
DWELLING
UNITS
jA_TURE OF WORK TO BE DONE
EXISTING STREET R/W ........... Fr- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... r"T. .... . .... FT
REMARKS
CAJI;CKED BY Z
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METER SIZE I SERVICE SIZE I CLEARANCE ICHECKED BY VA
REMARKS
TYPE CONNECTION I VERIFIED BY
I TYPE OF CONSTRU;
YES El NO
Plan Cheek No .....................
ftOPOSZDUSE
BUILDING
PLOT PLAN (Indicate Building setbacks. agutting -strects) PLUMBING
0 HEAT & GAS LINE
FENCE
t SIGN
N
RETAINING WALL
SWIMMING POOL
DEZIOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In,
formation given is 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- 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 PE101IT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIGNATJRE (0 NER OR AGENT I DATE SIGNED INSPECTION
t DEPARTMENT
i�, CITY OF
n� — EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
Ij YES [] No
Valuation Fee Receipt No.
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-
knowledged in space provided.
— /1� -6
This permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FILE
marquees, ete.) will require separate permission.
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