710017.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
NAME
126LT �owl,Ed'
-MAILING AD RE88
q�a�-
Applicant Fill
Inside Heavy Lines
04)/�r4/
amv�y�s Wly
�457.4-T kfMccS
ADDRESS J ,
ge'Ox - a-) 5-soi f A✓
TELEPHONE NUMBER
''�'Ti/I _
Ion of Property (Show Bel' or
94FL-T A
® RESIDENTIAL
LINE
.NEW
❑NON-RESIDENTIAL
❑
BION
ADD
RETAINING
❑
❑
DEMOLISH
EX
ALTER
❑
OR FILLTE
ElFENC
x..........11.)
REPAIR
❑
PRE -swim
IN P.
n
POOL
DWELLING
UNITS
OF WORK TO BE DONE
hV- '441 '0
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 authorised thereby, no person
will be employed In vlolatlon 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; MOVED -IN BUILDINGS shall be com-
pleted In mix months.)
NOTE: Applicant Subject to Plan Check Fee
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 permleslon.
C
Y
:ROLL MAP NO.:
PERMIT
% I
NUMBER
I
1
3ETBACK
STREET SETBACK
REAR Y
AREA
A VCANT
I
I Y11
BUILDING
LAN
J
a
17
M
EXISTING STREET R/W " . ....FT. DEFICIENCY is PROPERTY
COMP. PLAN ST. R/W,;.�ili....FT. ............FT.
REMARKS
Driveway slopes not to exceed those indicated
on Standard Drawing #103.
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BY
I JES ❑ NO
SPECIAL INSPECTOR REQUIRED OCC�yNCY OUP
i] YES **A NO IT_ I t \J _ 1
Plan Check No ..................... 4
BUILDING
PLUMBING
HEAT d: GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
Valuation
Fee
APPLICATION APPROVAL
No.
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.
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