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17P RMIT APPLICATION 7
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0701 �
YARD SETBACK
P NO.: PERMIT
NUMBER
STRErTSETBACK REAR
LOT AREA VACAN
I C ] YES
903-76
[] NO
I
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ For.
FIRE ZONE I TYPE
DADD
ElALTER
E]
NEW
REPAIR
RESIDENTIAL
NON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
0- INSP.
GAS
LINE
SIGN
RETAINING
WALL
PENCE
( ......... x .......... Ft.)
swim
POOL
[:] YES [] NO
PLAN CHECKED BY
REMARKS
I
NUMBER OF
Ir-
DWELLING
UNITS
Plan Check No .....................
BUILDING
PLUMBING
IrEAT & GAS LINE
PENCE
SIGN
3ETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
STREET IMPROVED
[] YES [:] NO
Fee
R
C;
Z
Z
W
No.
TOTAL AMOUNT DUE
1:50./
I hereby acknowledge that I have read this application; that the in-
7
APPLICATION APPROVAL
This application Is not a permit until
formation given Is correct: and that I tun 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 V�;;hlngton THIS PE11511T
relating to Workmanle Compensation Insurance.
NOTE: Permit Limit one Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
AUTHORIZES
ONLY THE
WORK NOTED
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
pleted In six months.)
FI-GNATURE (OWNER Olt AGENT) A GNED
INSPECTION
DEPARTMENT
ATU f
DIRECTOR'S BIGN;a
CITY OF
'L "O�
__D_A_TEo0"
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This rermit covers work to be done an private property ONLY.
Any construction an the public domain (curb@, sidewalks, driveways,
marquees, etc.) will require sepeamte pern-desion.
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