690271.pdfI
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BUILDING DEP,11RTMENT Applicant F111
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17PEIRMIT APPLICATION 0-11 G
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ALTER
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[-f RESIDENTIA
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I El NON-RESIDENTIA
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( .......... x .......... Ft.)
swim
POOL_
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
E3 INSP.
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
0
C/o
PERMIT -71
NUMBER A902
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SIDE YARD
SETBACK
STREET SETBACK
REAR YA.IUD SETBACK
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UMIGHT
I BUILDING AREA
I VARIANCE NUMBEH
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EXISiING'STRrET R/W ............ FT. DEFICHINCY THI13 PROPERTY
COUP. PLAN ST. R/W ............ FT. ............ IT.
P-1-IN
FIRE ZONE TYPE 01. CONSTRUCTION STREET IMPROV
11-17 ID 70'
INSPE;CTCRQUIRED OCCUPANCY GROUP
R
0 YES NO 1 7-1 �
Plan Check No ............ . .......
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I 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-
tzed agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
lating construction; and In doing thii work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS IIEI1311T
relating to Workmenla Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEIMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; hIOVED-IN BUILDINGS shall be com-
pleted lit SIX months.)
;IGNATURE (OWNER Olt A ENT)
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Ap�licant 6�jlect to Plan Check Fee
PH 0-1107
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, Sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
7.2-
Fee
j
I
to
APPLICATION APPROVAL
This application is not a pern-At until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
lmowledged In space provided.
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