700497.pdf.14�
BUILUINO utrAKIMCNI ApplicantFlU
I PERMIT APPLICATION Ins1do licavy Lines.
DDRESS
CITY
NAME
112 _117
14
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rELEPHONE NUMBER,
V
I CITY LICE
Show Below or Attach F
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NEW kL%,j RESIDENTIAL
1 1:1 NON-RESIDENTIAL
El�""
RDEMOLISH
ALTER EXCAVATE
R OR FILL
REPAIR E:] PRE -MOVE
INSP.
El
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( .......... x .......... Ft.)
swim
POOL
4UMBER OF ST E
NUMBER OF
DWELLING
UNITS
I C-)_ 0 W -
PERMIT
NUMBER
REAR YARD SETBACK
VACANT 81TE
r] YES C3 NO
VARIANCE NUMBER I Fu
EXISTING'STRELT R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ... 11 ....... FT.
I I I ?-Itf It
[3 YES [3 NO
Plan Check No ............ ........
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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- AYMNTION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Waabington THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DE51OLITIONS which %VORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
il.GNA��Ylt (OWNER OR AGEN DATE SIGNED INSPECTION
Al DEPARTMENT
lxpecx_;� CITY OF
k4iw"! I I EDMONDS
AVOTE: Appliratl4sbject to Plats Check Fee PR 0-1107
This Permit cisver% work to be done an private property ONLY.
Any coruttructiou on the public domain (curba, sidewalks, driveways,
marquees, etc.) will require separate permission.
[] YES El No
Valuation I Fee
APPLICATION APPROVAL
I
-1 -
i 1
No.
This application is not a perntit until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
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