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BUILDING DEPARTMENT Applicant 13111
r PERMIT APPLICATION inside Heavy Lines J013 ADDRESS let
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CITY
NAME
WDDRESS
CITY
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RESIDENTIAL'
AS
NEW
JAL
RGLINE
NON-RESIDENT I
SIGN
ALJV
.
RETAINING
WALL
0
DEMOLISH
ALTER
F1
EXCAVATE
OR FILL
PENCE
( .......... x .......... Ft.)
REPAIR
PRE -MOVE
INSP.
swim
POOL
,;UMBER TP STORIES
NUM13ER OF
DWELLING
UNITS
PERMIT 7
NUMBER 100360
Poe?
SETBACK REAR YARD SETBAFX
VACANT 817—"
:A 'E
El YES [3 NO Z
A VARIANcF, NUMBER
'E`X"I'S`r`1`N^G'1 �;REET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ IT. ............ FT.
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES 0 NO
SPECIAL INSPECTOR
0 YES 0 NC
CUPANCY GROUP
PLAW _CHECKED BY
REMARKS
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Plan Check No ........
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I
TOTAL AMOUNT DUE
ibet th a 'n-
I hereby acknowledge that I have read this application; that the In-
he r e' y
"arm
th or
formation given to correct; and that I am the owner, or the duly author-
"I to n g v c n U'y a u
law re gu
Ized agent of the owner, X agree to comply with city and state laws regu-
1 7 ed age nt 0 t h
ATTENTION
110 pers on
lating construction; and to doing the work authorized thereby. no person
lating con stru c tl
rJ
Washlogton
will be employed In violation of the Labor Code of the state of Washington
ou
wl I be e ployed
TIUS PERMIT
relating to Workmen's Compensation Insurance.
r at g to Wo"
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AUTHORIZES
[N
ONLY TILE
10 wh
; E Pern Ich
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
INS
I cm_
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
0 c
pleted in six months.)
pi e ted in six mol
INSPECTION
BIGNE
SIGNATURE (OWNER OR AGENT) DXIE SIGNED
GI,
DEPARTMENT
9 _ 1 0
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit covers work to be done an private P vporty ONLY.
Any construction on the public domain (curbs, sidewalks, drivew^Ys,
marquees, etc.) will require separate permission.
Fee
M
No.
1 �'5 0 1576t6
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-
Imowledged in space provided.
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