710087.pdfCy
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00
8
BUILDING DEPARTMEN
PERMIT APPLICATION
NAME
It
d
E] NEW
IXI ADD
ALTER
REPAIR
(UMBER OF 8
1
Applicant Fill
Inside Heavy Lines
L
N
C..
POSTED ON KROLL MAP NO.. PERMIT 08%
//� (J) • I NUMBER I
JOB ADDRESS
BIDE YARD SETBACK STREET SETBACK REAR. YARD SETBACK
UBE�Qj�IE I LOT AREA I VACANT SITE
'�(^`J�'{\ ❑ YES NO
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
RESIDENTIAL
GAB
LINE
❑YES
PLAN
NON-RESIDENTIAL
❑
SIGN
DEMOLISH
RETAINING
WALL
REMAI
❑EXCAVATE
FENCE
OR FILL
(... - ... ..x......... Ft.)
PRE -MOVE
swim
INSP.
POOL
'1ES
NUMBER OF
DWELLING
UNITE
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 lawn 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 DE51OLITIONS 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 coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Plan Check No......
RIC
A)/A
i
BUILDING 132G
PLUMBING- G
HEAT A 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 a-1107
6!
DEFICIENCY THIS PROPERTY
❑ YES ❑ NO
Valuation I Fee
3-oa
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.
3—Q-
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