700562.pdf0
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POST:
BUILDING DEPARTMENT Applicunt Fill
Inside Heavy Linjos
do He= JOB Jk'
PERMI T APPLICATION Inside Heavy
NAJ�f (OR N.ME 0 "BLNESS)
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or
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ARD BETB
PERMIT
NUMBER 700Z5*62
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11 �
15A
VACANT SITE
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CA I -VARIANCE NUMUNA
0'
ER
NUMBER
N UMB
5
STREET R/W
EXISTING STREET R/W.5. FT.
COMP. PLAN ST. R M'�(. XT.
REMARKS
DEFICIENCY THIS PROPERTY
.20 .... FT.
Driveway slopes not
to exceed
those indicateew
on Standard Drawing
#103
Z
CHECKED BY
NUMtBF-R
NUMBER
0
#TM
dA
__9,P6 '
3E NUM.BER
UM
METER)IIZE SERVICE SIZE CLEARANCE
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REMARKS
TYPE CONNECTION
VERIFIED BY
IS, �;_(Jvr�
PERO. TEST
PERMIT NOMER
NEW
RESIDENTIAL
1
El
GAS
LINE
NON-RESIDENTIAL
LE
0
SIGN
El ADD
__
RETAINING
ElDEMOLISH
WALL
EXCAVATE
FENCE
ALTER
FI OR FILL
( x Ft.)
REPAIR
PRE -MOVE
M
......... ..........
swim
POOL
INSP.
FUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
i
0 YES
Plan Check No ................. ...
?OSED USE
BUILDING
PLUMBING
r PLAN (Indicate Building tbacks, abutting streets)
HEAT & GA13 LINE
FENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
C\
DEMOLITION
A'
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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
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
THIS PEBMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be coln-
plated In six months.)
SIGNA;FU-RE(OWNER OR AGENT) DA E SIGNED
INSPECTION
4D
DEPARTMENT
/A -I(P -70
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6.1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
I
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Valuation
IMPROVED
No
H t %
l'q
VS1.
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-
knowledged in space provided.
—qq
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