710458.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
r+ NA (OR NAME OF HU,B/I�NE88)
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C M1ILINN0 ADDRESS
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NAME
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CITY TELEPHONE NUMBER
NAME
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ADDRESS
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CITY I TELEPHONE NUMBER
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STATE LICENSE NUMBER CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
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RESIDENTIAL GAB
NEW � LINE
NON-RESIDENTIAL SIGN
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ADD ❑ DEMOLISH ElWAS NINE
ALTER ❑ ORFILL
EXCAVATE (...NCE
.I.....lc......... Ft.)
REPAIR PRE -MOVE swim
❑ INSP. El POOL
NUMBER FSTORIES NUMBER OF
DWELLING J
UNITS /
NATU OF WORK TO !! DONE
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PROPOSED USE
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C PLOT PLAN (Indicate Building setbacks, abutting streets)
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I hereby acknowledge that I have read this application; that the In-
formation given to 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 retu.
laling 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 Your (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domalo (eurbe, sidewalks, driveways,
marquees, etc.) win require separate permission.
/ .101
LISTING STREET
COMP. PLAN ST.
indicated on
e
L] YES NO
PERMIT
NUMBER
IACK REAR YARD SETBACK].
VAO T B TE )r +
13 YES E3 NO '�pE7yi
LEA I VARIANCE NUMBER
i
DEFICIENCY TBIB PROPERTY
.... 0.... FT. t5
H�i eB not to exceed thou
Itandard Drawing #103.
CREC HY
LE SIZE I CLEARANCE I CHEdK2D BYAj
mp
VERI
11ll ;.
PEHM1 UMBER
L
m
1
OF CONSTRUCTION STREET IMPROVED .f
DYES ENO i
REQUIRED (OCCUPANCY GROUP
THIS SITE IS LOCATED IN THE
CITY OF EDMONDS. LOCAL SAE
TAX SHOULD BE CODED 31.0 .
See attached memo. 9-3-71
Plan Check No ..................
BUILDING
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR allot
l I &302,{
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.
D R'B Bi ATUR � ,a
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DATE ,
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