710406.pdf, . _:
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UILDIaG DEPARTMENT Applicant Fill
P Ile Heavy Lines OADD€EMIT APPLICATION
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of Property (Show Below or Attacn Your cope
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�O RESIDENTIAL ❑ GAS
NI N EW LINE
NON-RESIDENTIAL ❑ SIGN
ADD ❑ DEMOLISH ❑ RETAINING
ALTER ❑ EXCAVATE
❑ FEN..
ORFILLx.......... Ft.)
REPAIR O P. P
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INOOL
DUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
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I hereby acknowledge that I have read this 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 elate 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-
plete(j In slx,monthe.)
/� ✓�YG / ter%
NO; E: Applicant Suhjec to Plan Check Fee
This Permit coven work to be 4&ne on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
---- _------- _.----,
:I. MAP NO.: PERMIT
ITUMBER 710406
BACKI STREET SETBACK• I REAR YARD SETBACK
LOT AREA VACANT SITE
i] YES 4 NO �1
BUILDIN;� A �i I VARIANCE MBER •h7i
EXISTING STREET R/WS/�V"-�FT. DEFICIENCY PHIS PROPERTY
COMP. PLAN ST. R/W Y.II ...FT. Q..Axv.
REMAR'Triveway s opes not to exdeed those in—
dicated on Standard Drawing # 103.
W04Z__
FIRE
❑ YES
❑ YES �KNO I I � 37' 1
PLAN CHECKED BY
THIS SITE IS LOCATED IN 7H
REMARKS � W CAl nI*V OF CIJM NDS
TAX SHOULD BE CODED 31.0
Plan Check No .....................
BUILDING
PLUMBING
HEAT do OAS LINE Cl
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
G
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1.
atiun Fee Receipt No. c
N � t
N0b
1'00
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
Signed by the Building Official or his Dep-
ONLY THE
OTT
ut and fees are aid, and receipt is ac-
knowledged in space provided.
INSPECTION
DIRECTOR' ION TU
DEPARTMENT
CITY OF
DATE
r -0/1
EDMONDS
PR S-1107
FILE