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BUILDING DEPARTMEN
PERMIT APPLICATION
��
NEW
ADD
ALTER
REPAIR
.A
POSTED ON KROLL MAP NO.; PERMIT Applicant Fill I NUMBER 71048 1
Inside Heavy Lines JOB ADDRESS
I SIDE YARD SETBACK STREET SETBACK I REAR YARDSETBACK
I r
�04pa�001 R
MJ RESIDENTIAL
I I NON-RESIDENTIAL
El
DEMOLISH
EXCAVATE
17
OR FILL
j�
PRE -MOVE
I l
INSP.
DWELLING
UNITS
5--61 FD
OAS
LINE
SIGN
RETAINING
WALL
FENCE
(........ ..z.......... Ft. )
SWIM
POOL
,/2 1 1 ❑ YES
EXISTING STREET R/W .... ....... FT.
COMP. PLAN ST. R/W ............FT.
❑ YES ❑ NO
—
Plan Check No ........... ........
BUILDING
PLUMBING
HEAT d: OAS LINE
tRETAINING
FENCE
SIGN
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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.
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 BUIII.DINGS shall be com-
pleted in six months.)
NOTE: Applicant Subject to Plan Check Fee
Thin Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) win require separate permission.
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR e-1101
DEFICIENCY THIS PROPERTY
❑ YES ❑ NO
THIS SITE IS LOCATED IN THE
TAX SHOULD BE CODED 31.04.
No.
99
5T 166a
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.
Y
DATE
..._ _ .�.
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