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UILDING DEPARRENT Applicant Fill
Inside Ileavy Lines —!(-)-E
PERMIT APPLICATION 'PPU t Fin
1:y Lines
.11AM (OR NAME OF BUSINESS) _!;
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CITY ifffil"91-HION13ill ]NUMBER
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6._01
EXISTING'STREET R/W ........ .... FT -
COMP. PLAN ST. R/W ............ FT -
RESIDENTIAL
GAS
LINE
0 YES [] NO
CHECKED BY
NEW
PLAN
ON -RESIDENTIAL
SIGN
U
RETAINING
WALL
REMARKS
DEMOLISH
ErALTER
EXCAVATE
OR FILL
11
PENCE
( ........ . ..........
Ft.)
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE D NE
10 v
a
Man Check No .....................
z
0
BUILDING
PROPOSED USE
PLUM33ING
GAS LINE
PLOT PLAN (ludi
Building setbacks. abutting
streets)
BEAT &
FENCE
SIGN
tRETAINING
WALL
N
SWIM30NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
h r e
formation given Is correct; and that I am the owner, or the duly author -
orm a g
I tzed agent of the owner. I agree to comply with city and state laws regu-
zed a g n
ATTENTION
latlng construction; and in doing the work authorized thereby. no person
alto 0 n a
will be employed in violation of the Labor Code of the State of Washington
w b a e m p
THIS IPER511T
IIII
relating to Workmen's Compensation Insurance.
re at ff
AUTHORIZES
ONLY THE
NOTE: Permit r1mit One Your (Except DEMOLITIONS which
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be cona-
I b c 0
lete a RIX
p pie 0 all nths.)
SIGN WNER OR AGENT) DATE SIGN D
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Chick iee
/J
PR 6-1107
This Permit covers work to be done on private property ONLY.
T Is IP
Auy construction on the public domain (curb$, sidewalks, driverways,
'toy car
marquess, etc.) will require separate permission.
FA
PERMIT
NUMBER 690434
"M
VAC T SITE 7
YES
AAWEA 11 VARIANCE NUMBER
REA
THIS PROPERTY
[] YES 13 NO
I zi fj -0 140CS-224S Y
APPLICATION APPROVAL
This application is not a permit until
otgned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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