710115.pdft
BVILDING DEPARTMENT
PERMIT APPLICATION
.NAHIa(
Applicant Fill
Inside Heavy Lines
10 k 40,,-X a�v
hl
TELEPHONE NUMBE
CIM8�NUMBER I CITY LICENSE NUMI
or
i
1 rd.
The North
60.00 feet of Lot 6,
Block 9
.,r„
x i
RESIDENTIAL
El
NEW
LINE
.
ADD
NON-RESIDENTIAL
❑
SIGN
ElWAI
RETAINING
ALTER
DEMOLISH
EXCAVATE
PENCE
OR FILL
I .......... x.......... Ft.)
REPAIR
INSPMO�
El
SWIM
POOL
DWELLING
UNITS
c
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 authar-
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 Your (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 coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
ROLL W" NO.:
PERMIT
NUMBER
=BACK
STREET SETBACK
REAR
In
LOT AREA
I VA At
i] YES
USTINO STREET R/W
COMP. PLAN ST. R/W
710115
YARD SETBA(
T SITE
NO
DEFICIENCY THIS PROPERTY
Driveway s2ppes not to exceed those indicated
lI
on Standard Drwing #103
EV ' � LtMkC� pre.fc4VCG
.f 16t iOSI (�U !?6�e✓.
.
I. Jc___r— r v 113 YES p NO
SPECIAL INSPECTOR
REQUIRED OCCUP
YES
IyOGPI.T
PLAN CHECM /
/ e""V., ?'0
Plan Check No .....................
Valuation
Fee
Receipt No,
BUILDING
PLUMBING
^
HEAT & OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
"
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
1
TOTAL AMOUNT DUE
v�
]r
I qy /
ATTENTION
APPLICATION APPROVAL
TIUS PERMIT
This application is not a permit until
AUTHORIZES
ONLY THE
signed by the Building Official or his Dep-
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged In space provided.
INSPECTION DIRECTOR' SIGNAT IRE
DEPARTMENT
CITY OF
EDMONDS DATE 0 PR 0-1107 r 2 2,
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