710503.pdfr
BUILDING DEPARTMENT Applicant MU
PERMIT APPLICATION Inside Heavy Lines
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i ON XROLL MAP NO.: PERMIT (��
I NUMBER / �] 1 1 050 '
DRESS
�7 y' as'
USE ZONE LOT
LOT AREA VACANT SITE
f� _ K I 16 YES ❑ NO
EXI8TIN6 STREET R/W ............FT. DEFICIENCY THIS PROPER
TY
COMP. PLAN ST. R/W ............FT. ............FT.
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Ip' NEW
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RESIDENTIAL
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OAS
LINE
NON-RESIDENTIAL
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BION
❑ ADD
❑
DEMOLISH
WALLVINO
ALTER ❑
EXCAVATE
ORFILL
❑
EN CE
(........ . x.......... Ft.)
REPAIR ❑
PRE-VE
INSP. M0
SWIM
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
'
❑ YES J•NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT A OAS LINE
FENCE
SIGN
tRETAINING
WALL
N
ISWIMMING
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-
tzed agent of the owner. I agree to comply with city and state laws regu- ATTENTION
lating construction; and In doing the work authorized thereby, no parson
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shalt be com-
pleted In six months.)
lI=REER OR AG NT) ( DATE SIGNED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6.1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
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STREET IMPROVED
❑ YES NO
30UP
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CITY OF EDMOND& LOCAL
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Fee
77
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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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