710288.pdfJ
BUILDING DEPARTMENT Applicant Fill
- VERMIT APPLICATION Inside Heavy Lines
ev - ty(e
ptlon of Propel
IS
Below
NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
❑
SIGN
1 X I ADD
RETAINING
7❑""
❑
DEMOLISH
❑
ALTER
EJ
EXAVA
ORGFII.LTE
�
FENCx
Ft.)
..........
REPAIR
I I
111
PRE -MOVE
IN P
❑
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
%3
ZONE
C�
10•� PERMIT
NUMBER
PREET SETBACK
,-V 45-1
•�
r
I. • w
REAR YARD
/`SETBACK
VACANT SITE
❑ YES KNO
c
VARIANCE MBE"
F
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
THIS SITE IS LOCATED IN TH
REMARKS EI
TAX SHOULD BE CODED 31.0 .
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
TRETAINING WALL
N
I SKIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read thin application; that the In-
formation given In correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and stale 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 Year (Except DEMOLITIONS which
shall be completed In ninety days; BIOVED-IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applic oft to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drlvewa7s,
marqueen, etc.) will require separate perminslon.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDAIONDS
PR 0-1107
Fee
[L
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 ac-
knowledged in space provided.
! /7 1 1 • ) Al
DIRE,0TOR'S SIONA.TUF�E� !/.A r,:�`%),•,.._--'_
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RECORD
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IP
IP
Date Passed
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Plumbing (Partial)
(Rough)
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Furnace & Fuel Lines
i.
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TIONS
' Date Passed
e 'llt
4
PIP 4 PIP.
r rf Drainage LI
�,1 Sewer.
Parking
Landscaping..`, f
Fire Dept ,I
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n t P,
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