670141.pdfM
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POSTED ON KROLL MAP NO.: PERMIT bIU141
NUMBER
BUILDI DIPAIMNI Applicant Fill
D I NG
NG A Uc:7tFI
pp
9 vy
L 71nide In e IS
R
7 inside Heavy Lines JOB ADDREP
PERMIT APPLICATION
5�9
N r 110 M
(OR NAME OF BUSINESS) VOL,
A M P�7�_ �'_ _7 _� A
SIDE YARD SETBACK STREET SETBACK BEAR YA-RD
L
MAILING ADDRESS /yj 1�tq /\j a
g t —4 111— USE ZONE LOT AREA VACA.NT BITE
-7 — OJ
CITY TELXFHUNE NUMBER NO
CITY
1 —87 &-/-3 HEIGHT BUILDING AREA VARIANCE NUAlksmn 16
F1 ccA,1�6,0,6 I I,' X
791—)RESS
CITY IUMBER
I Sr
8
rroperty tbuow �iow or At=u rou
GAS
91*`RESIDENTIAL R LINE
NON-RESIDENTIAL I El SIGN
RETAINING
DEMOLISH WALL
EXCAVATE FENCE
ALTER OR FULL D ( X Ft.)
1
.......... ..........
PRE -MOVE swim
REPAIR INSP. POOL
:8
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
/0 01 W . r_. 0 -1 5
STREET R/W
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT-
L (
YES "NO
PLAN CHECKED BY
C(
Plan Check No .....................
PROPOSED USE
1—to
BUILDING
PLUMBING
PL OT PLAN (Indicate Build T%AtbT� abutting streets)
HEAT & GAS LINE
PENCE
SIGN
rn
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
z7q I
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
formation given In correct; and that I am the owner, or the duly author-
ized agent of the owner. 1 agree to comply with city and state laws regu-
lating construction; and in doing the work authorized thereby. no person
ATTENTION
will be employed in violation of the Labor Code of the State of Washington
THIS PEILT*IIT
relaUng to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit L' it One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shan be comPlete�dl.Lnlu'tyU�dayfi: 31OVED-IN BUILDINGS shall be com-
ye
s )�
pleted In six men s.)
INSPECTION
DEPARTMENT
SIGNED
61DATIE.
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Chcck Fce
PR 6-1107
—This Permit covers work to be done on private protwrty ONLY.
Any construction On the public domain (curbs, sidewalks. driveways,
marquees, etc.) will require separate permission.
B PROPERTY
0
T.
7Y 000,
(ED 13Y
C4
FE&W
7�
APPLICATION APPROVAL
This application is not a perinit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DIRECTOR'S SIGNATURE 7
DATE
FILE
I
1 0