700087.pdfJ
BUILDING DEPARTMENT
PERMIT APPLICATION
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Applicant Fill
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F�*71 RESIDENTIAL
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GAS
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1:1
NON-nESIDENTIAL
SIGN
ADD
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RETAINING
WALL
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DEMOLISH
0
ALTER
0
EXCAVATE
OR FILL
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FENCE
( ........ . x . ....... Ft.)
REPAIR
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PRE -MOVE
INSP.
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POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
PERMIT
NUMBER
— ye
00099
-2 -7�t S'
USE ZONIU LOT AABA VACZ� W
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0 YES P-NU n
I vAluAiAuisl NUMBER
�KTS;�NG_, STREET n/W ............ FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ IV.
0 YES [] NO
Plan Check No ......... ...........
BUILDING
PROPOSED USE PLUMBING
PLOT PLAN (Indlcaic Building setback,\abutting streets) HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
t
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 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
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall hu completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In at% months.) i -DATE SIGNED INSPECTION
DEPARTMENT
dM1 CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 0-1107
This permit coven work to be done On Private property ONLY.
Any construction on the public donuzin (curbs, sidewalks, driveways,
nuwquees, ate.) will require sepamte PerrnisslOn
Valuation
0 YES [] NO
No.
I �� , I is-3o
APPLICATION APPROVAL
This application Is not a permit until
aigned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
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