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UILDINO DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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P NO.: PERMIT _7000C
I NUMBER
SIDE YARD SETBACK I 13TREET SETBACK R90"RARD SETBACK
/ 4 _9 Z5— �� T-
UBE ZONE LOT AREA VACANT SITE
YES 13 NO
HEIGHT BUILDING AREA VARIANCE NUM"�
1 .3 o I
RESIDENTIAL
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GAS
LINE
NEW
M�"
NON-RESIDENTIAL
F�
SIGN
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
OR FIM
FENCE
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... . ...
REPAIR
El
PRE -MOVE
INSP.
SWIM
POOL
4UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
qATURE OF WORK TO BE DONE
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EXISTING STREET R/W -.47-Q-FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. n/w.&A.Fr. ....
0 YES
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Ap
Plan Check No ..................
BUILDING
PLUMBING
HEAT & GAS LINE
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PENCE
SIGN
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No..
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NE
tRETAINING WALL
N EMW
SWIMMING POOL
LIM
MON
DEMMOL E
PRE.MOVE a
PRE -MOVE INSPECTION
I P
E MCC V TIC 0 FILL
XCAVATION OR FILL
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-
ized agent of the owner. I agree to comply with city and state lawn regu-
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
relating to workman's compensation Insurance.
NOTE: Permit Limit One Your (Except DEMOLITIONS Which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six mon3hN
31ONA (Oqrrr O�N AGEN _5ATE SIGNED
710
,&Z!LV
.1e J, 112-12-&--
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be don on private property ONLY.
Any construction on the public domal: (curbs, sidewalks, drIVOWILYS,
nmarquees, etc.) Will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZE13
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
to exceed those
,d Drawing #103.
13 YES �O
ROUP
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Valuation I Fee
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APPLICATION APPROVAL
This application is not a permit until
signed by the Bullding Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
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