670250.pdfTOM
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Applicant Fill
Inside Heavy Lines
RESIDENTIAL
—1
F
GAS
LINE
NEW
i
-1
em
E]
NON-RESIDENTLALL
SIGN
D��
ElDEMOLISH
r_1
RETAINING
WALL
ElALTER
E]
EXCAVATE
OR FULL
FEICE
0& x.,?.-.I Ft.)
....
'�� 61-
REPAIR
PRE -MOVE
INSF.
S
POOL
NUMBER OF
DWELLING
UNITS
ON KROLL MAP NO. Z
PERMIT
I NUMBER
670250
'HESS
ig 5/ - ;�Vv tV
5-, a)
,RD
SETBACK
STREET SrTDACK
REAR YARD SETBACK
NE
LOT A.REA
VACA1yT SITE
1 (3 YES [3 NO
LDING!
AREA
I VARIANCE RUMBER IN
ExisTiNo_sTRmET R/w ........... YT. DEMcjwCy THIS PROPERTY
COMP. PLAN ST. R/W .......... .......... FT .
[3 YES [j NO
Plan Check No ............ . .......
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
FENCE
SIGN
N
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 In 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 PEILMIT
relating to Workman's Compensation Insurance.
AUTHORJZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed in ninety days; MOVED -UN BUILDINGS *hall be com-
pleted in six months.)
I �ER�,p AGENT)
IGNATURE (OWN
T ION ED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
This permit covers work to be done on private property ONLY.
Any construction an the public domain (curb@, sidewalks. driveways,
marquees, etc.) will ,equire separate permission.
[3 YES [3 NO
Fee
Z
14
No.
PPLICATION APPROVAL
MIS application Is not a permit until
d by the Building Official or his Dep-
and fees are paid, and receipt is ac-
ledged in space provided.
- -Z ,
FILE
I