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BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
G a d- Q o o ' NE. t,(y
CITY TELEPHONE NUMBER
,1 ofYNA11.* in nV� 17 do
NdE NUMBER
-b/ -- 64 99
or
cc AK -
QI /V NEW
RESIDENTIAL
�
OAS
LINE
"'77 "-"
NON-RESIDENTIAL
❑
SIGN
ADD
NING
❑
❑
WALLEl
DEMOLISH
ALTER
EXCA❑ OR FILL E
FENC.xFt.)
..........
REPAIR
El
PSIOVE
❑
swim
IN
i UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
ON KROLL MAP NO.:
PERMIT
NUMBER
REdB
^
,RD SETBACK(
STREET SETBACK
n %
-. 5'
NE
LOT AREA
BUILDING
rr
l I
�S` a
710442
YES ❑ NO
EXISTING STREET R/W R..F�T�. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. n/W . t: FT. ...L,�.IT.
REMARKS Driveway slopes not to exceed those
indicated on Standard Drawing 1rl03.
W
3
FIRE ZONE TYPE OF CONSTRUCTION I STREET IMPROVED
❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED
❑ I]YES NO
(OCCUPANCY GROUP
PLAN CHECKED
CITY OF EDMONDS. LOCAL S
TAX
REMARKS
1
—
Plan Check No ....................
BUILDING
PLUMBIN6_ )/
HEAT A OAS LINE
FENCE
SIGN
tRETAINING
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 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.) ,,�, i1
11-11-7/ 1
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (carbs, eldewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR a-1107
Fee
4W
� C
L
No.
l / % v c) 6t>2f16
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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