690446.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAM
.!.VR NAME OF BUSINESS)
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ADDRESS
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CITY�0, TELEPHONID NUMBER
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or
RESIDENTIA
9
GAS
LINE
19 NEW
I
El
NON-RESIDILL
NTIAL
SIGN
ElADD
RETAINING
WALL
DEMOLISH
EXCAVATE
FENCE
ALTER
OR FILL
F
( x Ft.)
E] REPAIR
PRE -MOVE
INSP.
.......... . ........
swim
POOL
iUMBER Or STORIES
NUMBER OF
DWELLING
UNITS
P
-2 -C,
PERMIT
NUMBER 690446
REAR YARD SETBACK
VACANT SITE
[3 YES [3 NO
—1
X
I
1 VARIANCE NUMffER
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ............ FT.
REMARKS
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FIRE ZONB I TYPE OF COJ
SPECIAL INSPECTOR REQ 1.
C] YES [3 NO
PLAN CHECKED 13Y
REMARKS
&1� * (0 1 a &�
Lr
P -0j'. (0 170q.3
Plan Check No ............ . .......
BUILDING
PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
PENCE
SIGN.
I
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in.
formation given In correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state Iowa 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 PER511T
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEIMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED-XN BUILDINGS nhall be com-
pleted In six months.)
ENT)
DATE SIGNED
INSPECTION
/0�— Ll 9'.
DEPARTMM T
CITY OF
EDMONDS
NOTE: Applicant ItIbject to Plan Check Fee
1119 0-1107
This Permit covers work to be done on private property ONLY.
Any construction On the public domain (curb#, sidewalks, drIvewayn,
marqueeso etc,) will require separate perrulasion.
0 YES [] NO
Fee
RE
No.
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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-
Imowledged in space provided.
FILE
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