710057.pdfBUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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:U ON KROLL MAP NU.: I NUMBER 710057
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SIDE YARD SETBACKI
STREET SETBACK II(EAR
YARD SETBACKI
UBE ZONE
I LOT AREA
VACANT SITE
❑ YES ❑ NO
HEIGHT
I BUILDING AREA
I VARIANCffi NUMBER
NEW
RESIDENTIAL
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ADD
❑
NON-RESIDENTIAL
❑ BION
KING
EJ
DEMOLISH
El WALL
ALTER
❑
ORFILL EXCAVATE
❑^ FENCE .x
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❑ REPAIR
❑
IN P.PRE-
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I POOL
DWELLING
UNITS
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I hereby acknowledge that I have rend 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'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 six 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 permission.
PLOT PLAN APPROVED
EXISTING STREET R/W ............ li-T. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............TT. ............ FT.
REMARKS
❑ YES
TYPE
❑ NO
IlanCheck No .....................
BUILDING
PLUMBING
HEAT & OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
rLV V*'Ni01OW]
TILTS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
Valuation
STREET IMPROVED
❑ YES ❑ NO
Fee
,00
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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