670112.pdfP,ING DEPARTMENT Applicant I=
IT APPLICATION Inside Heavy Lines
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GAS
NEW RESIDENTIAL LINE
Elft NON-RESIDENTL4,L SIGN
RETAINING
DEMOLISH 17 WALL
0 ALTER EXCAVATE PENCE
OR FILL M ( x Ft.)
........ . ..........
REPAIR PRE -MOVE SWIM
El INSP. POOL
ES
NUMBER OF
DWELLING
UNITS
ON KROLL MAP NO.: PERMIT
91 Ur NUMBER 670112
HESS
1.2 07 0
YARD BETBAUK
MD SETBACK STREET BETH REAR
LOT AREA VAC�l arm
RHIMING jUIZA 113 YES W-51;10 III ,I .. I
W
M
THT" R/W
1X]1STrNG STREET R/W ............ FT- DEFICIENCY THIS PROPERTY C
COMP. PLAN ST. R/W ............ PT. .......... IrT.
tEMARKS
CHECKED BY
dErrER SIZE I SERVICE OrZE I CLEARANCE CHEri 13Y
91 A / 1 �41 ( 0�_L_�
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lcasyaW /+J_ k4S6Pj6rj41 Plan Check No ............ . .......
PROPOSED U519
BUILDING
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11V16e6 '4Afo
12 PLOT PLAN (indicate 'Building setDacita, abutting streets) PLUMBING
HEAT & GAS LINE
PENC E
t SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
VA
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- 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 THIS PERMIT
relating to WorkmeWs Compensation Insurance. AUTHORllZZS
ONLY THE
NOTE: Permit Limit One Your (Except DEMOLITIONS which WORK NOTED
"I be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
SIGNATJRE (OWNER 0 ENT) -L)A17rj ul D INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subjectfo Plan Check Fee PH 6-1107
This permit covers work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
[] YES
tion Fee
'C9 C9 3,<'49 e2-
to 0
Receipt No.
:17
11��2 0&1 IkBivsn
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.
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