710160.pdfBUILDING DEPARTMENT AppllcantFut
PERMIT APPLICATION Inside Hoavy Lines
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g S�c� ttL:e ,r GYas IL'HY
• � STATE rIC>ENOB�E �Nji7MSIGtt /� CITY L CES
�'J / O d � /n' � f�
Legal Dmcriptlon of Property (8how Below or Attach Fc
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0
A
RESIDENTIAL
❑
LINE
i
� NEW
NON-RESIDENTIAL
❑
BION
ADD
❑
WALL VINO
✓ALTER
❑
DEMOLISH
E
�
❑
OROFILL
(r,.E..N...z..........Ft.)
REPAIR
❑
I2RBPMOVE
a
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
NATURE OF WORK TO HE DONE
�.
NO.1 PERMIT
NUMBER
.CANT BITE
yyyo
YE8 0 NO
tRIANCffi NUMBER
PWT YLA{Y Arrnv��� .I ./
BTREET RAW N /�J
EXISTING BTREET R/W ......._...FT. DEFICIENCY Tffia PROPERTY
COMP. PLAN 8T. R/W ............FT. ••••••••••••�•
� YEa
��� d .Q, •Z �' / 5 �/ /') G 5 �� �^ -P Plan Check No...._.._..-.......
z yyr7{7 ,�� WaLL TiGI a:C-tSSct.
' BUILDING
PROPOSED UBE
�,,� PLUMBING
L : Q L.(a x�O 7-- -P
, a PLOT PLA (Indicate Bulldtng setbacks, abutting streets) IiEAT & 6As LINE
//y�p� FENCE
L / N BION
�
RETADNIN6 WALL
ISWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOIINT DUE
I hereby acknowledge that I Gave read this aDPltcatlon; that lha la-
formatlon 61ven fe correct; and that I am the owner, or the duly author-
ised agent of the owner. I agree to comD1Y with city sad elate laws regu-
ATTENTION
latlag construction; and la dolnB tho work autharlsed thereby, no Dareon
will be employed In ylolatlon of the Labor Code of tha State of WmhWgton
TRIB PERMIT
relating to Workmen's Compeneatloa Imurance.
AUTHOBIZEa
ONLY TIQ:
NOYE: Permit Limit One Year (Except DEMOLITIONS which
{PORK NOTED
shall ba comDleled !a Nasty days; MOVED-1[N BUILDINGS shall be com-
pleted In elz months.)
INSPECTION
816NATUILE (OWNER OR AGENT) DATE SIGNED
DEPAP.TLIENT
' �/ �/�
'!/��a� '
U'. �r
OITY OF
EDMONDS
NOTE: Applicaftt S)Ibject to Plan Cbeck Fee
pR e-1107
Thle Yernut coven work to la done on Drivsle property ONLY.
Any conetractloo an the DabUo domain (curbs, sldewdke, drlvewge,
marqueeb eto.) wW regdre separate Dermleelon.
N/�
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)NBTRU
Valuation
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APPLICATION APPROVAL �
Thies application is not a permit until f �
signed by the Btlllding Official or hie Dep-
uty; and fees are paid, and receipt is ac- '.�'r ,
luiowledged in apace provided. �;y
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