670023.pdfPOS
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BUILDING DEPART ENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines 70—B
j1OR NAME OF BUMNIGHS)
:)N KROLL MAP NO.:
PERMIT
NUMBER
67100213
IESS
Rb SETBACK I
13TREET SETBACK
REAR YAUD SETBACK
LOT AREA
VACANT BITE
USE ZONE
0 YES [3 NO
BER
E NUMBER
�14 1
]TELEPHON
HEIGH T
VARIANCE NUMBER
-FL—OTPLAN APPROVED
pig
�j
13THEET R/W
EXISTING STREET R/W ...... ...... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.
TELEPHONE NUMBE-EC—
REMARK
Rz 1 e,-r e, /q
CHECKED BY
rA-
I
or
TYPE OF
[3 YEE; [3 No
I
M
0 YES 0 NO
PLAN CHECKED BY
GAS
DNEW RESIDENTIAL El LINE REMARKS
NON-RESIDENTIAL SIGN
ADD RETAINING
DEMOLISH WALL
ALTER EXCAVATE PENCE
PEI OR FILL El ( .......... x .......... Ft.)
REPAIR PRE -MOVE swill
1:1 INSP. El POOL
NUMBER OF STOFUE13 NUM131OR Oir
DWELLING
UNITS
_9A_TV RE OF WORK TO BE DONE
Valuation Fee -Receipt No.
rian check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets) PLUM]BING
HEAT & GAS LINE
PENCE
t SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
;�i
I hereby acknowled90 that I have read this application; that the In- TOTAL AMOUNT DUE 0
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 rogu- AT=NTION APPLICATION APPROVAL
lath2g construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building official or his Dep-
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt Is ac-
shall be completed In ninety days; BIOVED-IN BUILDINGS shall be com- knowledged In space provided.
pleted in six months.) INSPECTION DIVRECTIOR'S SIGN,
IG ATURE (0 DATE SIGNED �TU E
J�7 . 4
DEPARTMENT
A; rylu
3
r CITY OF
IV EDMONDS DATE'
NOTE: Apkcanl AIX
to'Plan Check Fee PH 0-1107
Tills Permit covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate pcmlssion.
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