670270.pdfa A
BUILDING DEPARTMENT
PERMIT
NUMBra
Applicallit Fill
PERMIT APPLICATION Inside Heavy
J013 ADDRESSj,,Lob
/4n,
NAM OF BUSINEaal
]Ltnes
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Is
SIDE YARD SETBACK
STREET SETBACK
_NMI(OR
M A ILING ADDRESS
72(
'Zo
USE ZONE
LOT ARER_
1 Z
0
4
Z
,yyC40 N—ffE—XGHT
or
El
NEW RRESIDENTIAL
ADD ED NON-RESIDENTIAL I
D DEMOLISH
ALTER EXCAVATE
El OR FILL
REPAIR PRE -MOVE
INSP.
El
E]
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( .......... x .......... Ft.)
swim
POOL
iUMBER OF STORIES NUtE - OF
J� DW L11`NG
.01je P, jQC&;2fj.,-,j UNITS
6702-110
=7— S
REAR YARD SETBACK
/u
VACANT SITE
0-11ES [] NO
VARIANCE NUMBER
STREET R/W
EXISTING STREET R/W$...9..FT. DEFICIENCY TMS PROPERTY
COMP. PLAN ST. R/W ............ FT. .4L..rr.
- 0007, &
BY
3 1 1 Qpml� cl NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
0 YES [>WO
x
PLAN CRECROD B
Plan Check No ...... ..............
PROPOS"
BUILDING
PLOT PLAN (Indici
to Building setbacks, abutt
ng streets)
PLUMBING
1
HEAT & GAS LINE
0
FENCE
13-
SIGN
/6
N
RETAINING WALL
SWIMM]ING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AI%IOU',%*T DUE
I hereby acknowledge that I have read this application; that the In.
formaUou given to correct: and that I arn 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
TIIIH PERINVIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
n
NOTE: Permit Limit 0 Y ar (Except DEMOLITION'S which
ONLY THE
WORK NOTED
shall be completed In ninety day T IVED-IN BUILDI.NGS shall be com-
pleted In six months.)
IIGNATUI (OWNER OR AGEYrT/Y
DA TE E31GNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit covers work to be done on private property ONT1:.___
Any construction on the pnbllo domain (curbs, sidewalks, drIveways,
maxquees, etc.) will require separate permission.
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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, find receipt is ac-
knowledged in space provided.
DIRECT0;RV;G7T11,,,
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