710375.pdfr�sr
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BUILDING DEPARTMENT
PERMIT APPLICATION
VAA
Applicant Fill
Inside Heavy Lines
GAS
RESIDENTIAL ❑ LINE
El NEW
SIDENTIAL ❑ NON-RESIGN
ADD RETAINING
ElT— .DEMOLISH 0 WALL
ALTER ❑ EXCAVATE FENCE
OR FILL (..._...i_.......Fl.)
PRE -MOVE swim
REPAIR ❑ INSP. POOL
NUMBER OF 8TOR1E8 NUMBER OF
DWELLING /
UNITS
404J. 0
.. - - ne`own.cn.c.mw+w.+:aw:aww ...._+.....
r 1.:
r 7'�
I
STED ON HBO" MAP NO.t IPERMIT
7 10375 � � �
I ADDREBB 1
)E YARD SETBACK STREET SETBACK REAR YARD SE TBACK 't !
/0f ate/ as
BE ZONE I LOT A=A I VACANT Biwa)
-
EXISTING STREET n/W ............AT.
P]:A
YES E3 NO
a]
DEFICIENCY THIS PROPERTY
............FT.
96 (1 ST
cxrsr
(] YES i] NO
THIS SITE IS LOCATED IN TH
CMARICS Ul I Y Ut' tUMr.i Iy UZI@ t.Vt MIw Jru
TAX'SHOULD BE CODED31.6
(3) P666' rlwvgooT5
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all
LNOT
TOTAL AMOUNT DUEereby acknowledge that I have read this application; that the In-n given !s correct; and that I am the owner, or the duly author-
nt of the owner. I agree to comply with city and stale laws regu- ATTENTION APPLICATION APPROVAL
netructloa; and In doWg the work authorised thereby, ao Berson
mploytd to violatlan of the Labor Code of the State of Weahington TIUs PERMIT Thies application is not apermit tmtlltb WorlkmenY ComDeneatloa Imurance. AUTIIOnIZEeONLY THEsigned by the Bullding Official or hie Dep-
Per a Year (Except DEMOLITIONS which WOIIH NOTED Uty; and fees are paid, and receipt is ak-
comp' ed In ninety da MOVED -IN BUILDINGS shall be cum- 1(nowledged in space provided.
six m ths.)RE (O ER OR AGENT) DATE SIGNED INSPECTION DIRECTO IG AT
DEPARTMENT
CITY OF
EDMONDS DATE
NJ
TE Aj) licant Subject to Plan Check Fee ? / ,
rR s-IIo7
This Pet c work to be done on private property ONLY.
Any conelructlou on the pubtle domain (curbs, ddewelks, drivewLys,
marquees, etc.) will require separate permission.
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