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BUILDING DEPARTMENT 1 Applicant Fill
PERMIT APPLCCATO01 inside Heavy Lines
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NBE NUMBER
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NEW'
ADD
ALTER
REPAIR
79-96_93
RESIDENTIAL
❑
OAS
LINE
NON-RESIDENTIAL
❑
SIGN
DEMOLISH
NfNG
RETAINING
❑
EXCAVATE
OR FILL
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L
FENCE
G.........x_........FtJ
I t
PRE -MOVE
INSP.
M
SWIM
POOL
DWELLING
UNITS
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 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; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
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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.
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ON KROLL YAP NO.:
PERMIT 710364
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RESS
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,RD SETBACK
STREET
SETBACK YARD SETBACK
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(REAR
NE
LOT AREA VACANT BITE
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I ❑YES. ❑ NO
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HUILDINO AREA I VARIANCE NUMBER
'.AN APPROVED
R/W
..,'
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ... ........ FT. ............FT. t7 �,'
❑ YES ❑ NO
Ful
Plan Check No........
BUILDING
PLUMBING
HEAT & OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR d-407
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CHECKED BY
I CLEARANCE -CHECKED
BY
VERIFIED BY
PERMIT NUMBER
STRUCTION IBTREET IMPROVED-
❑ YEB ❑ NO
'ED
(OCCUPANCY GROUP
1 .E
CITY OF EDMONDS. LOCAL SALES
ago
Valuation
Fee
Receipt
No
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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 ac-.
knowledged in space provided.
D OR'S SIONA%URE
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