710409.pdfF
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BUILDING DEPARTMENT
PERMIT APPLICATION
r_:I 0 a
ERA
15t336$"-
or
POSTED ON MOLL MAP NO.: I PERMIT
NUMBER 710409
Appli]NkMBER
Inside Ijog
ADDRESS
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SIDE YARD SETBACK STREET SETBACK REAR YARD SE.TBACIC
I I
c
USE ZONE LOT AREA VACANT SITE,EPHONE
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V
I I YES 0 NO
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STREET R/W I
EXISTING STREET n/W ............FT. DEFICIENCY TILIS PROPERTY I ,
COMP. PLAN ST. R/W ............FT. ............FT. ci
REMARKS LTi i
IVI GAS 0 YES 0 NO
ElNEW RESIDENTIAL LINE PLAN CHECKED BY
ED NON-RESIDENTIAL SIGN
ADD ❑ RETAININGAREMARKS
❑ DEMOLISH
ALTER ❑ ORFILL
EXCAVATE ❑ FENCE ..........Ft.)
REPAIR ❑ IRE -MOVE swim
POOL
(UMBER OF BTORIE9 NUMBER OF
DWELLING
UNITS
Plan Check No ........ ............
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGH
RETAINING WALL
N
1 SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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 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 bluely days; MOVED -IN BUILDINGS shall be uim-
pleted In six months.)
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NOTE: Applicant Su ject 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.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
a
w
m
0 YES
PROVED
❑ NO
THIS SITE IS LOUAItU nv
ITY OF EDMONDS. LOCAL
TAX SHOULD BE CODED
Valuation
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.
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