710088.pdf0
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BUILDING DEPARTMENT
PERMIT APPLICATION
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MAILING ADDRESS
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POSTED ON KROLL MAP NO.: PERMIT NUMBER I OC88 !i
Apr�llcant IrILL I �
Inside heavy Lined JOB ADDRESS i J
r+ / SIDE YARD SETBACKI STREET SETBACK I REAR YARD SETBACK
i
CST i TEL
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CITY TE/ EpHONE NUMBER/
23 67, -G
or
RESIDENTIAL
O
AS
INE
NEW
❑
NON-RESIDENTIAL
❑
SIGN
❑ ADD
RETAINING
❑
DEMOLISH
El
W
EXCAVATE
FENCE
ALTER
❑
FILL
OR FILL
❑
(xFt.)
..........
❑ REPAIR
❑
PRE -MOVE
INSP.
SWIM
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
t
I
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's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; 11OVED-IN BUILDINGS shall be com-
pleted In ctx month)
NOTE: Alilicant Subject to Plan Check Pee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, eldeealks, driveways,
marquees, etc.) will require separate Ccrmission.
-4—
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT -
❑ YES ❑ NO
REMARKS
Plan Check No .................
BUILDING
PLUMBING
HEAT A GAS LINE 6/1
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR d-IId7
,OG
VACANT SITE
❑ YES ❑ NO S
VARIANCE NUMBER
DEFICIENCY THIS PROPERTY
............FT.
Valuation
a
STREET IMPROVI
❑ YES ❑ NO
Fee
No.
�. oo �R3o
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-
lmowledged in space provided.
3—((),
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