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'DIN G DEPARTMENT Applicant Fill
MIT APPLICATION Inside Heavy Lined
02 BUSINESS)
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TELEPHONE NUMBER
7
ED ON KROLL MAP NO.: PERMIT —_
o ) I NUMBER 710086
YARD ETDACKj�
STREET SETBACK REAR YARD eETBA
'LONE LOT AREA VACANT SITE
YES ENO
'-
EXISTING STREET R/W ...(.f,,....FT. DEFICIENCY/THIS PROPERTY
COMP. PLAN ST. R/W ..<.e. ..FT. ..�:J••••IV.
REMARKS
Driveway slopes not to exceed those
indicated on Standard Drawing #103.
BER I CITY LICENSE NUMBER Q/I, p I 3/�(I I I V
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REMARKS
ow D r'
Iptionof Property (Show Below or Attach Four Copies) s/%/�•V nf
12
TYPE 4CONNECTION I VERIFIED BY
PERO. TEST PERMIT NUMISIIIR a.
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NEW
® RESIDENTIAL
I
El
GAS
LINE
❑
NON-RESIDENTIAL
❑
SIGN
❑ ADD
❑
❑
yALLKING
DEMOLISH
EXCAVATE
FENCE
ALTER
❑
FILL
OR FILL
❑
••...•♦....)
REPAIR
❑
MOVE
INSP.O
SMM
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
G
Cl YES X NO
L ■ Plan Check No .....................
BUILDING
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
1
RETAINING WALL
N
ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given Is correct; and that I s.m the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state lawn regu. ATTENTION
lat)ng 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
ONLY TILE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIGNATURE OWNER OR AGENT) DATE IONE INSPECTION
�
DEPARTMENT � CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
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.
0 YES � NO
SUP �r_ i
No.
OO
APPLICATION APPROVAL
This application is not a permit until
eigned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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