710572.pdfBUILDING DEPARTMENT I ApplIcantFM
PERMIT APPLICATION Inside heavy Lines
NAME (OR NAME OF BUBINE88)
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PERMIT
NUMBER
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710�r i2
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YARD SETBJ
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EXISTING STREET R/W �AD4WF.....FT. DEFICIENCY
THIS PROPERTY
COMP. PLAN ST. R/W <].46...r. Y........FT.
REMARKS Driveway slopes not to exceed those
indicated on Standard DraminR 'r103.
BER I CITY LICENSE NUMBER �W I -5& I I v
operty (Show Below or Attach Four Copies) n . _ n`Y (mow' ^w`� {]�(� / /► 3L4r /O e7- Ll
YES ❑ NO
GAS RESIDENTIAL ❑
❑ O
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PLANSCUEC D 8
LINE
NEW
NON-RESIDENTIAL ❑ SIGN
SITE IS LOCATED IN THE
❑ ADD RETAINING
DEMOLISH � WALL
REMARKS
CITY GF i.�.�'.'++ .I.•r l...•.\._ SALES
El ALTER a EXCAVATE ❑ FENCE
' OR FILL
_
.. •..�. l,J:..'C-!J 31.04.
TAX Eli! -I I;� •1 r... "&�' _-
❑ REPAIR ❑ IN P. ❑ PP�O('O1L
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5'65 J �USr /'6 �-raXV�.
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NUMBER OF STORIES
NUMBER Or
2
AWK
DWELLING
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oMoy ,
UNITE
NATURE OF WORK TO BE DONE
Valuation Fee Receipt No.
Plan Check No .... ........ .......
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BUILDING
a 6 i.40 8 p�
PROPOSED USE
PLUMBING
PLOT PLAN (IndicatBuilding ks, abutting streets)
HEAT & GAS LINE
7l Ord
FENCE
SIGN
tRETAINING
WALL
N
ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read thin application; that the 1n-
TOTAL AMOUNT DUE
formation given 1s correct; and that I am the owner, or the duly author•
Ised agent of the owner. I agree to comply with city and state laws rogu•
ATTENTION
APPLICATION APPROVAL
luting construction; and m doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
THIS PERMIT
This application to not a permit until
relating to Workmen-s Compensation Insurance.
AUTHORIZES
Signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
W K NTOTTEED
uty; and fees are paid, and receipt is ac-
■hall be completed In ninety days; MOVED•IN BUILDINGS shall be com-
imowledged in Space provided.
plated In six months.)
S16NA RE (OWNER OR AOEN ) DATE SIGNED
INSPECTION
DIRECT ei N
1(
C
DEPARTMENT
CITY OF
NOTE: Applicant Subject to Plan Check Fee
EDMONDS
DATE
PR a-Ilov
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
nar'puees, etc.) will reQmre separate permission.
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