700343.pdfa �4
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UILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
J6L
�� I
NEW
RESIDENTIAL
GAS
LINE
1:1
NON-11
SIGN
ADD
M
RETAINING
WALL
E] ALTER
DEMOLISH
EXCAVATE
OR FILL
PENCE
( X R.)
........ . ..........
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF STORIES
NUMBER OF
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 construction; 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 Your (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
C
MAP NO.: PERMIT
NUMBER
C� . . .
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
TYPE
0 YES [] NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
700343
BEAR YARD SETBACK
VACANT SITE
13 YES (3 NO
VARIANCE NUMBER
DEFICIENCY THIS PROPERTY
Valuation
[3 YES [j NO
NO.
rTOT" AMOUNT DUE &11
AMOUNT
A;r=ENTION APPLICATION APPROVAL
714
T T rZ
MS PERMMT This application is not a permit until
U�JOJUZI
AUTHORIZES signed by the Building Official or his Dep-
Oj� Y TR
ONLY THE
Wo i NOT, uty; and fees are paid, and receipt is ac
WORK NOTED knowledged in Space provided.
INSPECTION —5—LRECTOR'S SIGNATU
DEPARTMENT
cr.ry OF
DATE
EDMONDS 4/
PH 6-1107