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BUILDING DEPARTME14T Applicant FIII
PERMIT APPLICATIOI I Inside Heavy Lines
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CITY
STATE LIC
Legal Descr
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NEW
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ElNON-RESIDEfJIAL
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0
SIGN
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El
RETAINING
WALL
RDEMOLISH
ALTER
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EXCAVATE
OR FILL
0
FENCE
( .......... X .......... Ft.)
0
REPAIR
1:1
PRE -MOVE
INSP.
El
SWIM
POOL
NUMBER 0
DWELLING
UNITS
,%iATURE OF WORK TO 33E DONE
PERMIT
NUMBER
40,6- 6--0
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SIDE YARD Sit;TBACK brnzET SETB
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1-f /.,v c;? -1 *' Af 44
USE ZONLE J�V17 AREA VACANT ITE
--p s YES Ax NO
COMP.
STREET R/W ............ FT -
LAN ST. R/W ............ FT.
DEFICIENCY THIS PROPERTY
METER SIZE I SERVICE
SIZE CLEARANCE
ICHECKED BY
03
REMARKS
TYPE CONNECTION
VERIFIED BY
PERC. TEST
UMBER
REMARKS
FIRE ZONE TYPE OF 9WSTRUCT10N
_:i �/ Y:::� -- /SJ
STREET IMPROVED
(j YES No
SPECIAL INSPECTOR 2tN4UIlMlJ
0 YES XNO
OCCUPANCY GROUP
3
PLANCHECIFED BY
ki
-REMARKS' NJ
CIE No .....................
Plan Che �==
Valuation Ice
Receipt N 0.
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
tRETMNING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
/2LkC0tCC3j \2100
TOTAL AMOUNT DUE
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. ATTENTION APPLICATION APPROVAL
lating construction: and In doing the work authorized thereby, no person rTOTA
L AMOUNT
ATTENT"
will be employed in violation Of the Labor Code of the State of Washington TIUS PERMIT TMs application Is not a permit until
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relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building official or his Dep-
ONLY TIM
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NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be Com- Imowledged in space provided.
pleted In six months.) T
DATE SIGNED INSPECTION DIRECT:10
HGNATURE (OWNER OR AGENT)
DEPARTMENT
Cj�� 01
CITY OF
DATE %
EDMONDS
NOTE: Applicant Subject to Plats Check Fee PR 6-1107 Q "2
This Permit covers work to be done an private property ONLY.
Any construction on the public domain (Curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
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