690459.pdfa
BUILDING DEPARTMENT
PERMIT APPLICATION
- /" _�fA �
T
Applicant Fill
Inside Heavy Lines
I�
CARD
7 -k
P NO.: PERMIT
NUMBER bVU4�)�Y
STREET UNTIJAUA HEAR YARD SETBACK
LOT AREA VACANT SITE
'0'
4-10ES 0 NO
I VARIANCE NUMBER
I nTTITMING AREA
F_ I li�REET R/W,:T.- YT. DEFICIENCY THIS PROPERTY
PLAN ST. R/W'6_0..FT- ..4? ..... FT.
indicated on Standard Drawing
OffNEW
RESIDENTIAL
GAS
LINE
ADD
LEINON-RESIDENTLAL
SIGN
RETAINING
DEMOLISH
WALL
ALTER
EXCAVATE
OR FILL
PENCE
Ft.
I
. ........
REPAIR
r 1
PRE -MOVE
INSP.
swim
POOL
NUMBER OF
DWELLING
UNITS
,f.4
it
3.
W4
FIRE ZONE TYPE OF CONSTRUCTION
STREET IMPROVED
NO
SPE IAL INSPECTOR REQUIRED
13 YES
OCCUPANCY GROUP
_r / _.:r 1
Ott
PLAN CHE
,QKED BY
F
REMAPKS
Ky
r— I J= :>
Plan Check
Z
0
BUILDING
PROPOSED USE
PLUMBING
R
—PLOT _gb_U_tUng
PLAN (Indicate Building Netbaclo, streets)
HEAT & GAS LINE
PENCE
SIGN
r
iW
RETAINING, WALL
N
r(
64
SWIMMaNG POOL
DEMOLITION
PRE -MOVE INSPECTION
EKCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this apPlIcatlon; 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 PERMIT
rglgung to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; M0VFJ)-IN BUILDINGS shall be com-
pleted In six months-)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
* 'A 2- 4f
I
DEPARTMENT
—
aled—t-
CITY OF
wlim�
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PH 6-1107
This Permit Covers work to be done on private property ONLY.
Amy construction on the public domain (curb$, sidewalksp driverwayst
marqueess etc.) wW require separate permission.
Valuation I Fee
APPLICATION APPROVAL
No.
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.
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