700326.pdfApplicant Fill
BU11DING DEPARTMENT
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tMIT Inside Heavy Lines
FERMIT APPLICATION
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D RESIDENTIAL
El
GAS
LINE
ElNEW
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NON-RESIDENTIAL
El
SIGN
ADD
DDEMOLISH
El
RETAINING
WALL
ALTER
D
EXCAVATE
OR FILL
FENCE
( .......... x .......... Ft.)
REPAIR
F_j
PRE -MOVE
INSP.
SWIM
POOL
4UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
2,5- /
570 /
�p
66
PERMIT
NUMBER
7-
SIDE YARD SETBACK STREET HN'1'"Av� -Altl) BACH
/ I I / §7 /
LOT REA VXCANT '13ITE
USE ZONE [3 YES NO
--p s _17� — 19 _
_ 11
EXISTING I STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST.. R/W ............ IT- ............ FT.
OW4;joi
OF
[3 YES
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING WALL
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 In correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws ngu. ATTENTION
latin,% 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 rERhlIT
relating to Workmen's Compensation Insurance. AUTIIOIUZES
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.)
INSPECTION
;IG ATURE (OWN R Olt AGENT) DA IGNED DEPARTMENT
-1 lel2c, CITY OF
EDAIONDS
NOTE: Applicant Snbject to Plan Check Fce PR 6-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
nimrQuees, etc,) will require separate permission,
[] YES [] NO
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Valuation I Fee I Receipt No.
0
APPUCATION 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-
Imowledged in space provided.
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