710592.pdf1
BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
Applicant Fill
Inside Heavy Lines
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BE NUM EK I CITY LICENSE N MBEF
on of Properly (Show Below or Attach Four Copies)
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RESIDENTIAL O GAS [3 LINE YES ❑ NO
NEW ❑.PLAN CHECKED BY
NON-RESIDENTIAL SIGN
® ADD ❑ DEMOLISH ❑ RETAINING REMARKS
ALTER � ORCAVATFILLE ❑ FENCE
s- ........ Ft,)
REPAIR PRE -swim
❑ INSP.
❑ POOL Q E
LUMBER qF STORIES NUMBER OF
DWELLING
UNITS
Plan Cheek No...„„*cAe�
HVILDIN6
PLUMBING
abutting streets) HEAT 4 OAS LINE
PENCE
SIGN
RETAINING WALL
N
aWDdMIN6 POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly author-
ised agent of the owner, .1 agree to comply with city and state laws regu-
IaUng construction; and In doing the work authorized thereby, no person
Will be employed In violation of the Labor Code of the Stale of Washington
relating to Workmenes Compensation Ineurance,
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUMDINOS shall be com-
pleted In six mouttu.)
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POSTED ON KROLL YAP NO,: PERMIT '
NUMBER
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LOB ADDRESS
BIDE YARD SETBACK STRE ETBA K HEAR YARD SETBACK
/0 25
EONE LOT AREA VACANT BITE 1 I
YES O
HEIGHT _/ BUILDING AREA VARIANCE NUMBER !
PLOT PLAN APPROVED
STREET B/W i.
EXISTINO STREET R/W .... ....... FT, DEFICIENCY THIS PROPERTY
..FT.
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CHECKED BY
;LEARANCE CHECKED BY,
VERIFIED BY i
PERMIT NUMBER
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UCTI STREET IMPROVED _
i
(] YES NO �• , ,
^I OCCUPANCY GROUP
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THIS SITE IS LOCATED IN THE J
ITY OF ED O1 :, „l,.
TAX SHOULD C"_ Cu'"ED '21,04.
TOTAL AMOUNT DUE / I
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit untilIr
ONLY THE AUTHORIZES signed by the Building Official or his Dep- '
ONLY T
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in Space provided
VA RE (OWNER OR AO NT) ATE 810NED INSPECTION
DEPARTMENT
-
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR d-1107
This Permit coven work to be done on private property ONLY,
Any construction on the public domain (eorbs, sidewalks, driveways,
marquees, etc,) will require separate permission,
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