700253.pdfl
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
�perty (Show Below or
t XZ/� Ar
f
® RESIDENTIAL LINE
GAS
❑ NEW NON-RESIDENTIAL a SIGN
® ADD ❑ DEMOLISH RETAINING
CE
ALTER ❑ OR FILL FEN
FILL EXCAVATE ❑ .. x..........Ft.)
REPAIR PRE -MOVE swim
ElIN PI POOL
NUMBER OF STORIES I NUMBER OF
/ DWELLING
UNITS
;D ON KROLL MAP NO.: PERMIT 7
NUMBER 00253
DDRE88
1403 2, e 7 .s' 100v
YARD BET13ACK STREET SETBACK REAR ; ETBAO
// I a2,1(�
rZONE� 7� LOT AREA VACANT SITE
] ,J+� I I O YES NO
EXISTING
m-
;ET
RIM
............FT.
DEFICIENCY THIS PROPERTY
ST,
R/W
............FT.
............FT.
NO
(LC.Y-!4 / 5 / 3 /VI F- Flan Check Not.... ................
eX r t/ 1� BUILDING
�/%•
ROPOBED USE �f
(� PLUMBING
71101tlN I`1P�1WeltfC
PLOT PL (Indlcat Building not ks, ILbutting streets) HEAT A GAS LINE
So f
FENCE
BION
F V i 5 T' �( RETAINING WALL
/� ISWIMMING POOL
N DEMOLITION
'r( O . ♦ PRE -MOVE INSPECTION
OeC c, is over /�� 5 act f i %. EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin 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 be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NATURE (O OR AG T) DATE SIGNED INSPECTION
5 h v T DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PH 6-1107
This Permit covers work to be done on private property ONLY•
Any construction on the public domain (curbs, sidewalks, drivewa7s,
marquees, etc.) will require separate permission.
k
Fee 1 Receipt No.
4vao I55%Z
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-
knowledged in space provided.
FILE
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