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UILDING DEPARTMENT
: PERMIT APPLICATION
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Applicant Fill
Inside Heavy Lines
REAR YARD SETBACK
VACANT SITE 2 .
Q YES i7 NO
VARIANCE NUMBER `
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7Y ' IS PROPERTY 1
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..........FT. V.
m=2 Driveway slopes not to exceed those indicated
DDRESS ZlAn
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a - rez r on Standard Drawing #103.
!�� G CHECKED BY i
eery TELEPHONE NUMBER L'
��aI/1+ /' /'
TE LICENSE BEI METER SIZE I SERVICE SIZE I CEARANCE I CHEC BY
rA' CITY LICENSE NUMBER
or/ REMARKS 1+..
egal Description of Property (Show Below or Attach Four CoDinal
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TYPE CONNECTION I VERIFIED BY
�Z&ft PERC. TESTPERMIT NUMBER
REMARKS oe
FIRE ZONE I TYPE OF CON UCT1pI•I I STREET IMPROVED
!�i IL(Ilft'� es eta/, YES O 1111
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
OAS Q YES (l0
RESIDENTIAL ❑ LINE
NEW PLAN CHECKED ➢Y -
El
NON-RESIDENTIAL D SIGN ` 1`. �' • �'
ADD ❑O RETAINING
DEMOLISH REMARKS -
ALTER ❑ EXCAVATE ❑ FENCE
OR FILL (..........x._....... Ft.)
REPAIR � MOVE SWIM
INSP. POOL 1
UMBER OF 8TOft1EB NUMBER OF -
DWELLING I
UN T8 1
IATU E OF WORK T; —&E Do 1
Valuation Fee - Recelpt No 1
I hereby acknowledge that I have read this application; that the In-
formation given U correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and slate laws regu-
lating construction; and In doing the work authorized thereby, no patron
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
&hall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
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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.
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EXISTING STREET R/W
Plan Check No, ...............
If10600vlr,
IYA1;-T-14-R1r,
HEAT do GAB LINE
FENCE
SIGN
RETAINING WALL
L•WAIX1.a• 1i • a a
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
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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 III
1(nowledged In space provided. i
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