700140.pdfPOSTED ON KROLL MJ
BUILDING DEPARTMENT Applicant Fill
Inside Heavy Lines JOB ADDRESS
PERMIT APPLICATION -1 -
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NAME
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CITY TELEPHONE NUMBEI
Legal DUCrIPLIon of Property (Unow k5clow or Attach roUr Copies)
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154 RESIDENTIAL GAS
NEW D LINE
I E] NON-RESIDENTIAL I D SIGN
ADD RETAINING
El DEMOLISH WALL
DALTER EXCAVATE PENCE
El OR FILL ( .......... x .......... Ft.)
E] REPAIR PRE -MOVE SWIM
El INSP. POOL
NUMBER OF 13TORIES NUMBER Or
DWELLING
UNITS
NATURE OF WORK TO BE DONE
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PROPOSED USE
PLOT PLAN (Indicate Building setbacks, abutting streets)
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I hereby acknowledge that I have read this application; that the in.
formation given In correct: and that I am the owner, or the duty author-
Ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and in doing the work authorized thereby, no Verson
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS milail be com-
pleted In six months.)
IIGN�TUII VTNg AGENT) DATE SIGNED
70
AVNrE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivews7s,
marquess, etc.) will require separate permission.
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NO.: PERMIT
NUMBER -7
100140
STREET SETBACK
RE&K YARD SETBACH
LOT AREA
VACANT SITE
YES C3 NO
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BUILDING AREA
VARIANCE NUMNE—It
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ........ ... FT.
REMARKS
STREET IMPROVED
� �Va I ��
C] YES [] NO
REMARKS
Valuation I Fee
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
ME
No.
TOTAL A31OUNT DUE
5- VO
ATWNTION APPLICATION APPROVAL
TIUS PERMIT This application is not a permit until
AUTHORIZES
ONLY THE signed by the Building Official or his Dep-
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION DIRECTOR'S SIGNATR
DEPARTMENT
CITY OF
EDMONDS -70
PR 6-1107
FILE
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