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BUILDING DEPARTMENT Applloaldtm
PERMIT APPLICATION inside Heavy Lines
NAMM'E� (OR NAME OF BUSINESS)
0.
or
,
GAB
El RESIDENTIAL ElLINE
NEW NON-RESIDENTIAL
Sfax
ADD ❑ DEMOLISH El ❑WALL
RETAINING
ALTER ❑ OR FILL ❑ P...... •_...Fc.)
REPAIR PRE -MOVE SWIM
FI INBP. POOL
DWELLING
UNITS
c?2J PROPOSED USE
Q PLOT PLAN Indicate Building setback
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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 couxtruction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relattag to Workmen's Compensation Iusuraaoe,
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUIMINGS shall be coot-
pleted to six months.) _
/)
NOTE: Appli" t Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewAs,
marquees, eta.) win require separate permlasim.
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PERMIT
NUMBER —fig•-.i.—��
y Z e N^r•
IT SETBACK REAR YARD BETE
REA VACANT B TE
rl YES ❑ NO
STREET R/W ............FT. DEFICIENCY THIS PROPERTY
Q YES ❑ NO
;CTOR REQUIRED I OCCUPANCY GROUP
(] NO
BY THIS SITE IS LOCATED IN THE
OIYV OF Cnaenal) �
TAR §HOULD BE CODED 31.04,
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,Uo &ACAS PaWiMPO
Vnluntion I Fee I Recelnt I
Check No..._..___.......
44ki 1 )i ce
FENCE
SIGN
RETAINING WALL
p _.,
EXCAVATION OR FILL
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TKE
WORK NOTED
INSPECTION
DEPARTMENT
()= OF
EDMONDS
Pa 6.1167
3a
APPLICATION APPROVAL
This application is not a permit until S
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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