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BUILDING DEPARTMENT
PERMIT APPLICATION
NAME
Al
MAMINK
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REPAIR
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Applicant FIU
Inside heavy Linos
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RESIDENTIAL
O
LLINE
NON-RESIDENTIAL
❑
SIGN
❑RETAINING
DEMOLISH
EJ
WALL
FEXCAVATE
OR FILL
❑
FENCE
(.......... x......... Ft.)
PRE -MOVE
INSP.
El
swim
POOL
DWELLING
UNITS
1
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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 elate 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 Year (Except DEMOLITIONS which
shall be completed In ninety days; bfOVED-IN BUILDINGS shall be com-
pleted In nix months.)
/ /- 7.
NOTE: Applicant Subject to Plats Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (eurbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
F
771
\.
NO.;
PERMIT 7 10006
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7
I NUMBER
a
3TRE SETBACK
1
BEAR YARD SE BACK
10
a`
LOT AREA
VACANT BITE
I
13 YES J40
BUILDING AREA
I VARIANCE ITUM13ER
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1,
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,
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
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REMARKS
W
CHECKED BY
F
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
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NW
F
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REMARKS
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TYPE CONNECTION I
VERIFIED BY
PERO. TEST
I PERMIT NUMBER
.'
REMARKS
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TYPO OF CONSTRUCTIO(I STREET IMPROVED
"F�IR/E.ZONE I
,lv, YES ❑ NO
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'
SPECIAL INSPECTOR REQUIRED
OCCUPANQ ROUP
❑ YES NO .I
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PLAN CHNUMAIIY
Plan Check No............
BUILDING
PLUMBING
HEAT k GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6.1107
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