670268.pdfBUILDING DEPARTMENT I Applicant MU
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
03 —10 CILING AD�DRESS
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TELEPHONE NUMBER
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POSTED ON KROLL MAP NO.; PERMIT
61 NUMBER 670268
JOB ADDRESS V)�-
9�yo 0 � / �r ,* - J
SIDE YARD SETBACK STREET SETBACK REAR YARD HISTBACK
ta � a �- I /I I' Iq
VACANT SITE
USE ZON1.1 Lux AREA,
13 NO
=INCE riuhl�mn
HEIGHT -9-M—LDING AREA
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PLOT PLAN APPROVBL)
STREET R/W
EXISTING STREET R/W DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W 49�-4p-FT- -.A.XT. —
7/d t ( I 'S
R
Q X 0
DO
r4 FIRE ZONE TYPE OF CONSTRUCTION
Q 0 ki I
SPECIAL INSPECTOR REQUIRED OCCUPANCI
I] YES JeNO I I
X
NEW
RESIDENTIA
0
GAS
LINE
NTIA.L
NON-RESIDEL
F�
SIGN
0
ADD
RETAINING
ElDEMOLISH
El
WALL
0
ALTER
EXCAVATE
OR FILL
PENCE
( x Ft.)
.......... ..........
REPAIR
F-1
PRE -MOVE
INSP.
swim
POOL
Ell
NUMBER OF
4
10 t
DWELLING
UNITS
IPlan
N V_ Uj iE. Cq C, iF
Check No .....................
I k No
]�_ROPOSED USE
G
BUILDING
N
JING
PLUMBING
_FL_OT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAB LINE
PENCE
t
SIGN
(a
Iq# 4
N
RETAINING WALL
rNING W
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT 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-
ized agent of the owner. I agree to comply with city and state laws rcgu-
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 Workman's Compensation Insurance.
AUTHORIZES
ONLY TILE
NOTE: Permit Limit One Year (Except DF)IOLITIONS which
WORIC INOTED
shall be completed in ninety days; DIOVED-114 BUILDINGS shall be com-
pleted In six months.)
JIG14AT (_WNER OrACIEN
2711 NED
INSPECTION
-1
DEPARTMENT
AS
/ , 1,
CITY OF
EDMONDS
NOTE: Applicant Sitbject to Plan Check Fce
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, drlvtnvnym.
marquees, etc.) will require separate permission.
Z
P
13 YES 13 NO
Fee Receipt No.
Iq
.� t.,1 V 0 1 3
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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FILE