670059.pdfPOSTED ON KROLL MAP NO.: PERM T
670059
U'L D IN
BUILDING DEPARTMENT Applicant Fill
NUMBER
APPLICATION
Inside Heavy Lines
JOB ADDRESS
I
1.1 0 a IF
N (OR N
FPERMIT
=BUSINESS
SIDE YARD SETBACK
STREET SETBACK REAR YARD SETBACK
11"0 ADDRESS
LOT jLREA VAGAITE 15LTZi
USE ZONE
ITY
C CITY
LEFH—ONE NUMBER
0 YES NO
BUILDING AREA VARIANCE NUbl"Nt&
ow
HVIGHT
or
I f %
V
.1 "W10 Z" Y. 6rry 4�07 �4 t Y/
El
GA
LINE
NEW
LF;n.RESIDENTIAL
L-F-
NON-RESIDENTIAL
D
SIGN
ElDEMOLISH
RETAINING
WALL
EXCAVATE
PENCE
ALTER
n
OR Tim
( x Ft.)
REPAIR
n
PRE -MOVE
INSP.
.......... ..........
swim
POOL
DWELLING
UNITS
Z
PROPOSED V E
Q PLOT PLAN (Indicate HUIIdjj;_Vbac putiAl&-streets)
6 )
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT-
13 YES
[] NO
Plan Check No ............ . .......
BUILDING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the in-
formation given to 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.
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DFIHOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
Pi
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be dune on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways.
marquees, etc.) will require separate permission.
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR B-1107
DEFICIMINCY THIS PROPERTY
........... 1".
13 YES 13 NO
Valuation Fee
I 5�00 I
RM
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.
EMA
M
I
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