670293.pdfBUILDING DEPARTMENT Applicant Fill
' , :' ".: - . � -P I Inside Ileavy Lines
ERMIT APPLICATION
XABM: (on NAME OF BUSINESS)
RIM $t lf'1:1�'),�'NTCKUM PROPERTIES, INC.
1_71
Columbia Street
I , .
. lulliPRONE NUB
tle, Wn.
mu 2-4390
"tZtaRley W. mar
ADDRESS
203 Alaska Trade Bldg.
TELEPHONE NU!
tle 4 WrLe
MA 3-09
& RACE
IN
ADDRESS
11323 East Rive Side Drive
CITY
Bothell, Wn.
HU 6-1418
or
NEW
El
RESIDENTIAL
I
GAS
LINE
NON-RESIDENTIAL
F�
SIGN
RETAIMNQ
WALL
0
DEMOLISH
ALTER
n
EXCAVATE
OR FILL
FENCE
( .......... X .......... Ft.)
REPAIR
n
PRE -MOVE
INSP.
SWIBI
POOL
ES
NUMBER OF
DWELLING
UNITS
POSTED ON KROLL MAP NO-: PERMIT
NUMBER 670293
JOB
SIDE YARD SETBACK STREET SETBACK HEAR Xjutff SAkcir
1? 45? / -.2-- eq / 0
USE ZONE LOT AREA VACANT _FMTE��
Al 13 YES
77 DEFICIENCY Tina PROPERTY
rG STREET n/W ............ FT.
PLAN ST. R/W ............
FT.
.18
IQ
SIZE SEgksiz
LE
G
I
I Inn—
I
R5
C] YES
PVN CHE KE P BY
74 1
OF
Plan Check Nol= ... Ld--A? 4
PROPOSED USE
BUILDING
PLOT PLAN (IndFc—ate Building setbacks, abutting streets) PLUMBING
HEAT & GAS LINE
FENCE
t SIGN
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 elven 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
lating constmcUon; and In doing the work authorized thereby. no person
will be employed in violation of We Labor Code of the State of Washington THIS PERBUT
relating to Workmens Compensation In-sumnee. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; BIOVED-IN BUILDINGS shall be com-
pleted In six months.) INSPECTION
SIGNATURE JOWFiNkc Utt AVZT� i DATE SIGNED
DEPARTMENT
IK CITY OF
511 -- EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Permit coven work to be done on Private property ufv�'-
Any construction on the public domain (curbs, sidewalks, driveways.
marquees, etc.) will require separate permission.
Valuation
_i�o
A
0 YES
Fee -Receipt N 0.
I / Z' -3 , vtl� 0 1
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.
NATU
-7
,2,
FILE
I
3
t
I
i