660569.pdfBUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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ON KROLL MAP NO.: PERMIT
// I NUMBER (,(,0569
RESS
RD SETBACK STREET SETBACK RE" YARD SETBACK
S
RE LUW AREA VAC SITE 4
YES NO
I BUILDING, AUNA I VARIANCE NUMBEW 94
727 1410E 0 EXISTING STREET R/W ............ PT. DEFICIENCY THIS PROPERTY 0
7 76 (jg t COUP. PLAN ST. R/W ............ FT.
t REMARKS
CHECKED BY Z
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mBER METEB SIZE SERVICE SIZE CLEAJtANCE CHECVVe 33Y
PHONE NJ 7k ck (C
U
RLICHARKS \j
r LICENSE NUMBER
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AS
E�_NEW L!J�ESIDENTIAL El LINE
i El NON-RESIDENTIAL I El SIGN
RETAINING
DEMOLISH 0 WALL
ALTER EXCAVATE PENCE
0 OR FULL ( .......... x .......... Ft.)
'REPAIR PRE -MOVE SWIM
1:1 INSP. POOL
TUMBER OF STORIES NUMBER OF
DWELLING
UNITS 10 -M.A7
'E CON14ECTION
4,--Oc-
[I YES
PLAN CHECKED BY 1.1�7
I
Z_44ze 4��'
Plan Check No .....................
PROPOSED USE
BUILDING
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PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUM33ING
5_5
HEAT & GAS LINE
FENCE
t
SIGN
10
N
RETAINING WALL
SWIM NG POOL
V
DEMOLITION
C)
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT 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-
ATTENTION
I&ting Construction; and in doing the work authorized thereby. no Person
will be employed In violation of the Labor Code of the State of Washington
Tins PERMIT
relating to Workmen!5 Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE31OLITIONS which
OINLY THE
WORK NOTED
shall be completed in ninety days; 3,10VED-IN BUILDINGS shall be com-
pleted In all months.)
DATE SIGNED
INSPECTION
DEPARTMENT
Owe,
CITY OF
EDMONDS
NOTE: Applicant Subloc"a to Plan Check Fee
Pn 6.1107
This Permit coven work to be done on privnto property ONLY.
Any construction on the public domain (curbs, sidewalks. driveways,
marquees, etc.) will require separate permission.
[3 YES
Fee
I Y
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
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