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DWELLING
UNITS I— 2001A
MAP NO.: PERMIT NUMBER rj "] I O I Q
USE ZONE �� y I LOT AREA ` I VAOANI S TE
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STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY TRIG PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
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BUILDING
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o� PROPOSED USE
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APLOT PLAN (Indlcate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING
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POOL
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DEMOLITION
PRE -MOVE INSPECTION
—_
EXCAVATION OR FILL
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I hereby acknowledge that I have read this application; that the
TOTAL AMOUNT DUE
!% D /�
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
ATTENTION
THIS PERMIT
APPLICATION APPROVAL
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
ONLY TILE
{YORE( NOTED
uty; and fees are paid, and receipt is ae-
lfnowledged in space provided.
pleted In six months.)
SIGNATURE (OWNER Olt AGENT) DATE SIGNED
/
INSPECTION
DEPARTMENT
DIREC 'S SIGN
CITY OF
EDMONDS
-
DAT
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
� .-
FILE
This Penult covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways.
numquees, etc.) will require separate permission.
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