690355.pdf0
BUILDING DEPARTMENT—JApplie
POSTED ON KROLL MAP NO.:
PERMIT
690355
ant FLU
PERMIT APPLICATION
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JOB ADDRESS
NAME (OR NAME OF BUSINESS)
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SIDE YARD SETBACK
STREET SETBACK
REAR YARD SETBACK
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MAILING ADDRESS
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USE ZONE
LOT AREA
VACANT SITE
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YES AQ NO
CITY
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TELEPHONE NUMBER
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BUILDING
AREA
VARIANCE NUM-1
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EXISTING STREET R/W ........... FT. DEFICIENCY THIS PROPERTY
REMARKS
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d>r 022 — Aj PERC. TEST PERMIT NUMBER
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—1 RP.MARICR
NEW
RESIDENTIAL
im
GAS
LINE
EDNON-RESIDENTIAL
SIGN
P9ADD
RETAINING
F1
WALL
ElALTER
DEMOLISH
EXCAVATE
FENCE
OR FILL
El
( x Ft.)
REPAIR
El
PRE -MOVE
INSP.
........ . ..........
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POOL
rUMBER OF STORIES
NUM13ER OF
DWELLING
UNITS
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SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
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Plan Check No ..................
BUILDING
PLUM11ING
HEAT & GAS LINE
PENCE
SIGN
I
tRETAINING
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FULL
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-
—
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 rEMUT
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; AIOVED-IN BUILDINGS shall be com-
pleted in six months.)
jIGNATURE (OWNER OR AGENT),
DATE SIGNED
INSPECTION
C11
DEPARTMENT
Crry OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This rermlt covers work to be done on private property ONLY.
Any construction on the public domain (curb$, sidewalks, driveways,
marqueest etc,) will require soparate permission,
Valuation
Fee
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.
DIRECTOR' TUP9
I