690323.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION inside Heavy Lines
It NAME OF HUBINLSS)
_'10 �7
C4
t
Legal Description or Property (show Below or Attach Four Copies)
Section lot 145, D-4 Meadowdale Beach
4 Beg. at a pt 575 ft. East and 303 ft.
N of the SW cor of Tract 145 Th E 147 Ft.
tit N 130 ft. th w 87 ft. th N to the N
n4 livieti th F. - Ong N linp 234 ft- th S to
the point of beg. less county road.
E] NEW
ADD
ALTER
E] REPAIR
IN RFSIDE14TIAL
LE-1 NON-RESIDENTIAL
GAS
LINE
SIGN
RETAINING
WALL
PENCE
( ........ . x .......... Ft.)
swim
POOL
MDEMOLISH
EXCAVATE
M OR FILL
E:] PRE -MOVE
INSP.
FUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
P NO.:
/ Z/ /
DDRESS
YARD SlTrBACK
0 /A 1
PERMIT
NUMBER
= Z, &J 4
'BACK
REAR YARD SETBACK
VACANT SITE
YES NO
REA
I VARIANCE NUMBER
N
EXISTING STREET R/W ............ FT. DEFICIENCY TIIIS PROPERTY
COMP. PLAN ST. R/W ........... FT. ............ FT.
R=ARKS
[] YES [] NO
Plan Check No ............. ... ...
BUILDING
PLUMBING
tRETAINING
N
HEAT & GAS LINE
FENCE
SIGN
WALL
SWIMMING POOL
DEMOLITION
PRE-MOVP INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In-
formation riven 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-
latIng construction; and In doing the work authorized thereby, no person ATTENTION
will be employed In violation of the Labor Code of the State of Washington TIUS PERMIT
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-
plated In six months.)
AT RE (OWNER OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
6? F— CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PH 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (carbs, x1dewalks, driveways,
marquess, etc.) will require separate pmnisslon.
M
[3 YES [] NO
Fee
No.
1 C7, 0 0 1.5-1 �62
APPLICATION APPROVAL
This application is not a permit until
eigned by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
DATE /U
0-z 0
FILE