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Applicant Fill
PERMIT
APPLICATION
Inside Heavy Linos
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ADDRESS ` '�J
21 166 , 6I l., STREET R/W
i? EXISTING STREET R/W ..._.......FT.
CITY I TELEPHONE NUMBER
.� -. . _,. � . I COMP. PLAN ST, R/W ............FT,
m ADDRESS
��. CITY T.
STATE LICENSE NUMBER I C.
Legal Description of Property (Show Below or
_T �� � n 0, &�i r_
RESIDENTIAL O LINE L-PLAIN
YES NO
NEW CHECKED BY
NON-RESIDENTIAL ❑ SIGN
❑ ADD DEMOLISH ❑ wA L AINING ARKS t
ALTER EXCAVATE FENCE
OR FILL (... ..... ..�c_....... Ft.)
REPAIR PRE -MOVE SWIM /,/INSP. POOL �n 1 a oj. .
DWELLING UNITE 1
r t�v\a %v rJ +o Phan -ChecK No, .................
C. BUILDING
PROPOSED USE
PLUMBING
Q PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT d: GAS LINE
Id
FENCE
SIGN
RETAINING WALL
IBWDdMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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 authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen'a Compensation Insurance.
NOTE: Permit Limit On ear (Except DEMOLITIONS which
shall be co pletad In uihely dayy; MOVED -AN BUILDIN08 shall be com-
pleted Ity�x mooks.) 9L X,
NOTE: Applicant Subject to Plan Check Fee
This Permit coven
work to
be done
on private property ONLY.
Any construction on
the public
domain
(curbe, sidewalks, driveways,
marquees,
etc.) will
require
separate permission.
0
TOTAL AMOUNT DUE
'erg •.
PERMIT
NUMBER 710034
0034
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TRACK REAR YARD SETBACK
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\ VACANT BITE
YEB [3NO
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I AREA VARIANCE NUMBER!
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DEFICIENCY THIS PROPERTY I
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tecelpt No.
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ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
al�YORIZES
hi signed by the Building Official or s Dep- 11
RORK NOTED uty; and fees are paid, and receipt is ac- A
1(Ilowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
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