670279.pdf. A
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BUILDING DEPARTME14T I Applicant FIR
PERMIT APPLICATIOI Inside Heavy Lines
j"'O.4 0
0 ADDRESS
At )-- 7 At—
r KROLL MAP NO.;
SETBACK I STREET
PERMIT
NUMBER -670279
SETBACK RZAI' x�m SETBACK
SIM A-g �/J� 0
FA VACAN'1'011�
&�;B 13 NO
10 AREA I VARIANCE NUMBER
EN38TING STREET R/W
K ........ FT.
DEFICIENCY THIS PROPERTY
TELEPHONE NUMBER
M
COMP. PLAN ST. R
11W.FT.
REMARKS
1
METER SIZE SERVICE
SIIZE CLEARANCE
C BY
LEPHONE NUMBER
TZ
�6
7 MAR KS
_
al Description of Property (Show Below or Attach Four Copies)
PERO. TEST
MeN P:
ij YES
19NEW
WRESIDENTU
R
GAS
LINE
1
11
NON-RESIDI TIAL
SIGN
ADD
RETAINING
0
FJ
WALL
DEMOLISH
EXCAVATE
FENCE
ALTER
0 OR FILL
( x Ft.)
REPAIR
PRE -MOVE
R INSP.
.......... . ........
swim
POOL
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
Valuation
[] YES [:I NO
Plan Check No ............ . .......
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Buildin-9setback8. abutting streets)
PLUMBING
el 0
HEAT & GAS LINE
FENCE
14 t
SIGN
j-05450W N
RETAINING WALL
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 Is 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
APPLICATION APPROVAL
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
Tins PERMIT
This application Is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the BuUding official or his Dep-
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ONLY THE
JVORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
pleted In six months.)
SIGNATURE (OWNER OR AGE T) VAT SIGNED
INSPECTION
SIGNAT
DII:�
DEPARTMENT
VTO,,-11
r -1
CITY OF
EDMONDS
DATE
NOTeAPPficant Subject to Plait Check Fee
PR 0.1107
Tide Permit mvers work to be done on Private property ONLY.
P f E
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
nuLrqueen, etc.) will require separate permission.
N