720106.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
J!. NAME (on NAME OF BUSIINNNOB)r/1
aUj ADDRE
CITY
NAME
i BI A�
CITY
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r STATE
1 - Legal
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J10 RESIDENTIALM El GAB
NEW LINE
NON-RESIDENTIAL ❑ SIGN
ADD DEMOLISH RETAINING
I.
CE
ALTER ❑ ORFILL
EXCAVATE (�...N 3_..... ..Ft.)
❑' REPAIR El INSPMOVE ElPOOL
DWELLING
UNITS
It
I
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-
Ired agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the Stale 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 oom-
pleled In six months.)
SIGNATURE (OWYfR OR AGENT) DATE SIGNED
NOTE:
to Plan Check Fee
This Permit coven
work to
be done on privets property ONLY.
Any construction on
the public
domain (curbs,
sidewalks, driveways,
marquees,
etc.) Will
require separate
permission.
DURESS
YARD SETS
D `
ZONE
15-/5�
IT
P NO.; PERMIT
NUMBER
:2 5 r 11 075
AREA
�y,/ VACANT BITE1ey
TER
LDING AREA VARIANCE NUB
3��76t
eLI. & M/W
EXISTING STREET R/W&2.... FT. DEFICIENCY THIS PROPERTY
eJrivc::ay slopes not to e.:cecd thole
Led on 3' Land ar(l Dra;aino - 103.
m
THIS SITE IS LOCATED
TAX SHOULD BE -CODED
Plan Check Nos .......... ......
ass®
=iliA04We,
IuAiLy -8 fttf�I;
1: �1)<ir��efFl2i is
FENCE
SIGN
RETAINING WALL
i7�a(•1hwvY•).i
PRE -MOVE INSPECTION
EXCAVATION OR FILL
No
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TOTAL AMOUNT DUEI I I V653
ATTENTION APPLICATION APPROVAL
THIS PEnMIT Title application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-ONLY THE
I -
WORK NOTED utv; and fees are paid, and receipt is ac- 1
lmowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
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