710470.pdfA
`BUILDING DEPARTMENT I ApplicantF111
PERMIT APPLICATION Inside Heavy Lines
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RESIDENTIAL
NEW
LINE
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ADD
NON-RESIDENTIAL
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SIGN
NING
❑
WALL
ALTER
DEMOLISH
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❑ OROFILL
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REPAIR
n PRE -MOVE
INSP.
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SWIM
POOL
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PERMIT
NUMBER
71,0470
/6 1
VACANT BITE
YES IYNO z3
VARIANCE M24BER I j4
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
OF
YES ❑ NO
❑ YES 7J!NO I �, I —
THIS SITE IS LOCATeD It
Ty OF IMMDg LOCAL
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DWELLING
UNITS
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NATURE OF WORK TO/B'EE DONE
Valuation
Fee
Receipt No.
ciDiNi-
flan Check No ........ _...........
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BUILDING
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—
PROPOSED USE
pLVMBIN6
HEAT & 6A8 LINE
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PLOT PLAN (Indicate BUlldl e�gbuttl
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ete)
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Y
FENCE
SIGN
RETAINING WALL
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SWIMMING POOL
-
DEMOLITION
1
PRE -MOVE INSPECTION
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O
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EXCAVATION OR FILL
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1
O
TOTAL AMOUNT DUE
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-
J
lzed 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
ATTENTION
APPLICATION APPROVAL
.�
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 to six months.)
THIS PERMIT
AUTHORIZESONLY THE
WORK NOTED
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.
1
INSPECTION
DEPARTMENT
CITY OF
BION TURE (OWNER OR� T)
Cry e
DATE 01ONED
/ 7/
D TOR' GNAT �� +
i C P.t:
EDMONDS
PR 6-1107
� .
,
NOTE: Applicant Subject to Plan Check Fee
DATE
71
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewo3ke, driveways,
marquees, etc.) will require separate permission.
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. e.nm.. ror uie aoove worx is nereoy approvea, suniecc to the aoove conclitions, anu to compliance with the ap•
proved plansand specifications, and Building Department notations thereon.
`!'his Permit does not cover Plumbing, Sewer or Electrical installations.
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Bldg. set -backs — front ............................ r. side........ ................. 1. side ............................. rear ...: ..... ...
Owner....p '
h
2�/... .
Bar-r'i,e ....... Address.A... .. Tel.. No
.... ..`y
Builder:.::.. .................. .:.:...... Address........... ... .................. Tel..No ....::........ .::..:;
Plans b , :. Address....._
y.: ..............:........_. ........ ............................. -Tel. No
Remarks.. ...... .................. .: .. ....... . .....
The above is a correct statement, and I agree to comply with all applicable Codes and State. laws. regulating ?this
work
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Signed Owner/Agent.__. .Y.. ... ... ......�L���" Address. Date. a
PERMIT .for the above work is hereby approved, subject to the above conditions, and to compliancewith the:ap
proved plans and specifications, and Building Department notations thereon.
Valuation .................................................... Permit fee......... ...................... Recd. by....� .......`�'
....... ............. ............... Date........................................5 .....Buitdin Department, By ....... ....
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