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RUI_LDING DEPARTMEN
PERMIT. APPLICATION
NAME (OR NAMES OFBUSINESS)
MAILING A DREBB
O=Id Q 4z
6a 3 31=-`4 S. C
74
222�-0 1— I G 68
EM
Applicant Fill
Inside Heavy Lines
—.5- o
43 ?�f-%!r o a
®GAS
NEW RESIDENTIAL ED LINE
. NON-RESIDENTIAL SIGN
Foo"!' ADD ❑ DEMOLISH ❑ ww L
ALTER EXCAVATE FENCE
OR rim � (........ ..x......... Ft.)
REPAIR wim
Fool IN PMOVH ED POOL
2 uwcr.
UNITS
I hereby acknowledge that I have read this application; that the In-
formation given to correct: and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws regu-
latlbg construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's ComDensatlon Insurance,
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted to six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED,
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domalo (curbs, to �alke, driveways,
nuurquees, etc.) will require separate l )salon.
IN I
..,,_,..."....•_........._..�+..�.-..—......,......_u w..._....rye+.+-.-...^'_.:rY.�....r.. L J
ioZf1
USE NUS t 730348
IRS -12 JOB^. —
ADDRESS
LE�VA OOERAGE m"IAGE �Q
PERMISSIBLE HEIGHT FRO OSED HEIGHT
O
3C� 2_S .
ACTUAL LOT AI TOTAL BLDG, AREA
EQUIRED YARDS PROPOSED YARDS
FRONT BIDE REAR FRONT BIDE REA
i
.LIP
6AL LOT VARIANCE OR CONDITIONAL USE
YES ❑ NO PERMIT NUMBER ,
(
ILI
NO T OV DA i.�.
BTRE R/W
EXISTING STREET R �( ... DEFICIENCY THIS PROPERTY )
COMP, PLAN ST. R/IIEF� f�. ...Q.FT.
REnswRxe Driveway slope not to exceed those
b
f
D1i:,rc�RliL�:
Plan Check No,...................
BUILDING
PLUMBING
HEAT A OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
I
APPLICATION APPROVAL
This application is not a permit lentil
signed by the Building Official or his Dep- j.
uty; and fees are paid, and receipt Is ac-
knowledged in space provided
O S 8I NATUREI
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