710240.pdfI
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BUILDING DEPARTMENT
PERMIT APPLICATION
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ADDRESS
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POSTED ON KROLL MAP NO.: PERMIT
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I NUMBER
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Lines
IUBADDRESS
71ns1dcHcavy
SIDE YARD SETBACK STREET 118TDACK
nEAR YARD HETBA
USEE4orm
LOT AREA
VACANT SITE
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YEH NO
HEIGHT
I SUILUIN6 AREA I VARIANCE NUMIIEI
RESIDENTIAL
❑ GAS LINE
NEW
ADD
NON-RESIDENTIAL
❑ gION
RETAINING
❑ DEMOLISH
❑
ALTER
❑ On FILL EXCAVATE
El <ENCx
Ft.)
❑ REPAIR
ElPNSPI,fOVE
..........
BP OM
NUMBER OF STORIES NUMBER OF
DWELLING
/
UNITS
/
NATURE OF WORK TO BE DONE '
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 Cods 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; MOVED -IN BUILDINGS shall be com-
pleted In six months.) _.
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
TYPE
O YES [3 NO
DEFICIENCY THIS PROPERTY
BY
❑ YES in NO
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REMARKS
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Fee
Plan Check No......
1ilisF�]i:G'
PLUMBING (7)
HEAT do GAS LINE.
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
No.
TOTAJ, AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application Is not a permit until
AUTIIORIZES
signed by the Building Official or his Dep-
ONLY TILE
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DIRXG2
DEPARTMENT
CITY OF
DAT
EDMONDS
�' 7
_ PR 0-1107
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