710030.pdf! BUILDING DEPARTMENT
PERMIT APPLICATION
NAME
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IL1NG ADDRESS
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Applicant Fill
Inside Heavy Lines
PERMIT 0030
NUMBER lJ
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BIDE YARD SETBACK(
STREET SETBACK (REAR
YARD SETBACK
USE ZONE
LOT AREA
VACANT SITE
❑ YES ❑ NO
HEIGHT
I BUILDING AREA
I VARIANCE NUMBER
RESIDENTIAL
GAS
ElNEW
LINE
NON-RESIDENTIAL
❑
SIGN
ADD
KING
K71
❑
WALL
❑
i❑�
DEMOLISH
PENCE
ALTER
OROFII.AL
El
xFt.)
REPAIR
❑
PRE-WIM
.........
POOL
INSP.
(UMBER OF BTOILIES
NUMBER OF
DWELLING
I
UNITS
PLOT PLAN APPRUVNIJ
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............I`:.
REMARKS
C1
3
FIRE ZONE TYPE OF CONSTRUCTION
STREET IMPROVED
❑YES ❑NO
SPECIAL INSPECTOR REQUIRED
❑ YES ❑ NO
OCCUPANCY GROUP
PLAN CHECKED BY
REMARKS
Plan Check No ..... ...............
Valuation
Fee
RecelPt No.
BUILDING
PLUMBING
HEAT & GAS LINN
FENCE
SIGN
RETAINING WALL
N
ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have road 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 e.nd state law" 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 PERMIT
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 com-
pleted in six months.)
IIGNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
r
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 8-1107
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.
s J XZMIMI
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.
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FILE
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