670155.pdfa
BUILDING DEPARTMEN ------Applicant ]F111 POSTED ON KROLL
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PERMIT APPLICATIM Inside Heavy Lines jOB ADDRESS
NAME (OR NAME OF BUSINESS)
SIDE YARD SETBAZ
21AILING ADDRESS 1v7 it-J
USE ZONE
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CITY I TELEPHONEI� NUMBER
,-7
ADDRESS
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RESIDENTIAL
GAS
LINE
NEW
ADD
NON-RESIDENTLIL
SIGN
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
PENCE
Ft.)
OR FILL
( .......... x ..........
REPAIR
PRE -MOVE
swim
INSP.
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
ET R/W
hNG STREET R/W
&P. PLAN ST. R/W
t(
t
FT�RErT 811�
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PERMIT
NUMBER
070155
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REAR YARD SETBACK
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VACANT SITE
NO
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EA
.
I VARIANCE NUMBER 194
DEFICIENCY THIS PROPERTY
4
73�B;Y?
LANCE
I CHELKND BY
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FIRE Z OF CONSTRUCTION STREET IMPROVED
YES axo
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
0
IJ YES
PLAN CHECKED BY
HE
Plan Check No ................ . ...
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets) PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
0 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-
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
wlII be employed In violation of the Labor Code of the State of Washington TIUS PERMIT
relating to Workman's Compensation Insurance. AUTHOIUZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NED INSPECTION
3IGN DATE 810
,%P3TURE PWNEP
OYAYENT) DEPARTMENT
,A
CITY OF
EDMONDS
NOTE: Applicant Subject to Plait Check Fee PR 6.1107
This PermIt covers work to be done an private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate permission.
Valuation I Fee I Receipt 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.
DIRECTOR'S SIONAT7RE
DATE
FILE
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