660571.pdf660571
POSTED ON KROLL MAP NO.:
PERMIT
BUILDING
DEPARTMENT Applicant Flu
NUMBER
PERMIT
Inside Heavy Lines
APPLICATION
JOB ADDRESS
I '1� C"4'
__
a
,_ -
or
GAS
1__LT`;EW L�rRESIDENTIAL_ n LINE
NON-RESIDENTLAL n SIGN
RETAINING
n DEMOLISH n WALL
EXCAVATE FENCE
ALTER
n Olt F71LL E] ( x Ft.)
.......... ..........
PRE -MOVE SWIM
REPAIR
1:1 INSP. POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
� 4�- �z s— � t�� / 0
;ONE LOT AltEA VACANT SITE
— A:�: I ZK9�s_ g3 NO
I BUILDING AREA I VARIANCE NUMBER
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLA.N ST. R/W ............ 147. .......... 1".
REMARKS
CHECKED BY
METEJE� SIZE I SERVICE SIZE CLEARANCE CHECR1FP BY
3/4A
RE14CARKS
0L.y1j,j(2jZ
[3 YES
Plan Check No ............... ....
PROPOSEI) USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GA13 LINE
FENCE
SIGN
RETAINING WALL
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 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-
ATTENTION
lating construction; and In doing the work authorized thereby. no person
will be employed in violation of the Labor Code of the State of Washington
TIUS PERMIT
rolaUng to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE31OLITIONN which
ONLY THE
WORK NOTED
shall be completed In ninety days; VED-IN BUILDINGS shall be com-
pleted In six months.) If
3IONAT (OWNER OR AGE
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Platt Check Fee
PR 6-1107
This Permit covers work to b5 done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
xnarquees, etc.) will require ReParate permission.
YES
No.
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.
I � y tp
FILE Pr (11
, A
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77)
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