670200.pdfI NMI
D11PARTMINT Applicant Fill
1�.,"TERMIT APPLICATION Inside Heavy Lines
ITAME (OR NAME OF BUSINESS)
CITY TELEPHONE NUMffU1
1c, - /7,�-74, #
POSTED ON KROLL MAP NO.: PERMIT
/.;). 0 W I NUMBER 11�70200
JOB ADDRESS
*7_4 1pe
15u U_^_4 Ai�a,
SIDE YARD SETBACK STREET SETBACA REAR YA.RD SETBACK
/0 " lq",N 2 S_ 'M 1"'Al ? S__ ' M I H
ONE LOT AREA MAA�
[3 NO
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,cIs(CjNo'sTRE=. R/W fj5! ..... FT. DEFICIENCY
COMP. PLAN ST. R/W 67 FT. ... 9
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y (Show Below or Attach Four Copies)—=
ption. of Propert
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ErRESIDENTLA 'L
AS
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NON -RESIDE
,NTIAL
SIGN
RETAINING
DEMOLISH
WALL
ALTER
EXCAVATE
OR FULL
PENCE
( x Ft.)
REPAIR
PRE -MOVE
INSP.
.......... ..........
swim
POOL
NUMBEI OF
R
DWEING
14-1 UNITS
IATUREF W0700 BE
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TYPE
Plan Check No ..... ...............
PROPOSED USE
BUILDING
_F_OT
L PLAN (indicate Building setbacka, abutting streets)
PLUMBING
HEAT & GAS LINE
Ir
FENCE
SIGN
N
1
6 Or
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given to correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and stato laws regu-
ATTENTION
latiul; 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
relaUng to Workmen's Compensation Insurance.
AUTHOIUZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TICE
WORK NOTED
shall be completed In ninety days: 31OVED-IN BUILDINGS shall be com-
pleted in six months.)
SIGNATUI WNER Oft AGENT)
DATE SIGNED
INSPECTION
7
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
Pn 0-1107
This permit coven work it, he done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate pernflaslon.
Valuation
US PROPERTY tz
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00,�
BY
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Fee
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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-
lmowledged in space provided.
b - A �4
FILE