710450.pdfBUILDING DEPARTMENT I Applicant FLU
PERMIT APPLICATION Inside Heavy Lines
or
RESIDENTIAL
GAS
LINE
NEW
❑
NON-RESIDENTIAL
sisal
ADD
RETAINING
❑
DEMOLISH
D
,
PENCE
ALTER
❑
ORFILL
❑
(x..........Ft.)
REPAIR
❑
PRE-WIM
INSP.
O
P OL
VUMBER OF STORIES
NUMBER OF
�J
I DWELLING
UNITS
t
N
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 or 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 Y ar (Except DE1 IONS which
shall be completed In ninety OVED-IN B S shall be com-
pleted in six months.) ' , --( rn��
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curb&, sidewalks, driveways,
marquees, etc.) will require separate permission.
POATrt] ON KROLL MAP NO.:
PERMIT
NUMBER
710-, `r`0
/v
USE ZONE LOT AREA VACANT BITE
I0YEB ❑NO
EXISTING STREET n/w c��+�..FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/Wq_.0..FT. ...C>T•
REMARKS Driveway slopes not to exceed those
indicated on Standard Drawing #103.
Rpo viO.E Fo 12 " ,7'iG E VT �.P�✓�•�ira
ZONE I TYPE OF
❑ YES ❑ NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAB 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 6-1167
❑ YES ❑ NO
THIS SITE IS LOCATED IN TH
TAX SHOULD BE CODED 31.0
Valuation I Fee
StI
- ,-. Sri 1411 1
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,
��-r j
FILE �
�I
i
,
11
Ed
IIti:Y+•:Y.IY-�'�.y��w�waw+j �-+.�_�•ar.�.� .1
y h�
a ..
97, 67tr
a'
I