700274.pdfV, 1
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BUILDING DEPARTMEN
PERMIT APPLICATION
WWI
WI n 1.41
MA,
/405—
ADDRESS
CITY
—ITTATEI —LICENS
Legal Descriptio
40775,
Zem ZY
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4/
4
17,F-2
or
Applicant Fill
Inside Heavy Lines
,09 AJ /Y
W12
_:a� 4 3
NEW
Li RESIDENTIAL
GAS
LINE
NON -RESIDENTIAL
D
SIGN
ADD
RETAINING
DEMOLISH
WALL
EXCAVATE
FENCE
ALTER
OR FILL
x Ft.)
REPAIR
1:1
PRE -MOVE
INSP.
........ . .........
SWIM
POOL
Z
DWELLING
UNITS
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-
lating conAtructl0n; 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 Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
iffo= MAP NOA PERMIT
NUMBER
YARD BETE
SETBACK STREET SETBACK
LOT AREA VACANT BITS
� %�N 1 13 YES Cl No
EXISTING STREET R/W ............ FT -
COMP. PLAN ST. R/W ............ FT-
9
[3 YES 0 NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENC17
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
DEFICIENCY THIS PROPERTY
0 YES 13 NO
Fee
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
latiowledged in space provided.
JATURE (OWNER OR AGENT) ."DATE SIGNED NSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PH 61107
_Fh_1s Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
nuLrquees, ege.) will require separate permission.
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