670283.pdft
POSTED ON KllOLL MAP NO.: PERMIT t.-)7(3283
BUILDING DEPARTMENT Appll—t Fin NUMBER
inside HeavY Lines —j-013 —ADDRESS
PERMIT APPLICATION 1
1 (0 Z--NAME �OFBUSINESS) 7 P/ co too
NA D SETBACK
I . BLPTB CK STREE C K
.............
eg-te-R M d A
M G ADDRESS SITE
'tl 's . USE ZONE LOT AREA
LV YES 0
0 0 k i
0 of E NUMB je % f VARIANCE NUMIShm
HEIGHT BUILDING AREA
NAME
PLOT PLAN APPROVED
ET It/W
NE NUMBER EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
TPULEM55
-CIT—Y R/W ............ Fr. ..........
COUP. PLAN ST- R/-%V
REMARKS
NAM
CHECKED By Z
ADDRESS
1Z CHECKED 33Y
ONE NUMBER METER SIZE SERVICE B E CLEARANCE
CITY I I
REMARKS
FIRE 2
SPECI:
F] YES
NEW
RESIDENTIAL
E]
A
U
NON-RESIDENTIAL
sIGI:
ADD
F]
DEMOLISH
RET NG
AIM
WALL
El ALTER
n
EXCAVATE
OR FULL
PENCE ........
( .......... X.. Ft.)
REPAIR
n
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
t
N
I
I hereby acknowledge that I bave read this application; that the in-
formatlOU 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 rOgu-
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
relating to WorkmeWs Compensation Imurancb.
NOTE: Permit Limit One Year (Except DENIOXITIONS which
shall be completed in ninety days; MOVED -IN BUILDXNOS shall be com-
pl,ted in six months.)
NOTE: APPlicant Sitbject to Plat; Check Fee_
ate property ONLY.
This rervalt coven work to be done on priv
Any construction on the OUbtle dOOM111 (curbs, sidewalks. driveivaYs.
marquees, Cie.) will require separate pernilsolon.
[] NO
rtan Check No .....................
BUILDING
PLUBMINIG
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A51OUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
[] YES E] NO
valuation I Fee
0 1 3
1 3. a 0 13 9-(/;,
APPLICATION APPROVAL
This application is not a perinit until
signed by the Building official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
11
idw-Unnama
9