710508.pdf•
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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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ORFILLEXCAVATE
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❑ REPAIR
❑
PRE -SWIM
INSP.
❑
POOL
(UMBER OF STORIES
NUMBER OF
DWELLING
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UNITS
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PERMIT
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NUMBER
'BACK
STREET
SETBACK
REAR YARD SETBACK
LOT AREA .
VACANT SIT E �+
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I [3 YEB [�NO
I SUILDSN6 AREA
I VARIANCE N HER
PLOT
PLOT PLAN APPROVmO
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STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY '
COMP. PLAN ST. R/W ............FT. ............FT. zDz
REMARKS ty
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STREET IDfPROVED '
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❑ YES NO
0 YES [] NO
THIS SITE IS LOCATED IN THE
REMARKS GITY OF .- . LMAL SALES
TAX SHOULD BE CODED 31.04.
Plan Check No............
BUILDING
PLUMBING
HEAT d: OAS LINE
FENCE
SIGN
RETAINING WALL
iSWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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 BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drlVeways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR d-1107
Valuation
No.
" 1 Gl;�6_3
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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