710531.pdfBUILDING DEPARTMENT AppllcantFlll
PERMIT APPLICATION Inside Heavy Lines
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i Least Descrinuon of Property (Show Below or
RESIDENTIAL
LINE
NEW
NON-RESIDENTIAL
SIGN
ADD
RETAINING
NINE
ElDEMOLISH
ALTER
❑
OROFILL
ElAVATE
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..........
1 /�I REPAIR
❑
PRE -MOVE
INSP.
1:1SWIM
POOL
(UMBER OF STORIES
NUMBER ON
DWELLING
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UNITS
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PERMIT 71
U/J3 I
NUMBER
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LACK I REAR YARD SETBACK
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VA:;ANT SITE
❑S NOI LEA I VARIANCE NUMBER IN
EXISTING•STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
TYPE
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YES ❑ NO
❑ YES C7,N0 I _L.
PLAN CHECKED THIS SITE IS LOCATED IN THE
REMARKS TAX SHOULD BE CODED 31.04.
Plan Check No .....................
BUILDING
PLUMBING
HEAT & CAS 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-
tion given Is correct; and that I am the owner, or the duly author -
agent of the owner. I agree to comply with city and state laws raga-
ATTENTION
construction; and In doing the work authorized thereby, no person
e employed In violation of the Labor Code of the State of Washington
TIUS PERMIT
g to Workmen's Compensation Insurance.
AUTHORIZES
[NOTE:Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
be completed In ninety days; MOVED -IN BUILDINGS shall be com-
In six months.)
T RE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
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CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (turbo, sidewalks, driveways,
marquees, etc.) will require separate Permission.
Fee
1 /b ` 1 LC5�
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.
FILE
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