670346.pdf- - - - - - - - - - -
POSTED ON KROLL MAP NO.: PERMIT
Applicant Fill NUMBER (_�70346
BUILDING DEPARTMENT
PERMIT APPLICATION
Inside Heavy Lines
joB ADDRESS
I
1011 NAME OF BUSINESS)
1
(1NAME
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SIDE YARD - SETBACK
STREET SETBACK
HEAR YARD SETV
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11-1
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14
6r,rq,,14
CN4
MAILING ADDRESS
-.20
- ao
— A / —
or
DADD
0
MA
NEW RESIDENTIA
NON-RESIDT! TIAL
0 DEMOLISH
ALTER EXCAVATE
D OR FULL
REPAIR PRE -MOVE
INSP.
R
GAS
LINE
SIGN
RETAINING
WALL
PENCE
( .......... x .......... Ft.)
swim
POOL
NUMBER OF
RA< i711A �N,4
DWELLING
UNITS
USE Zo LOT A.REA VACANT SITE
1.0n
OT EI YES 13 NO
HEIGHT BUILDING AREA. VARIANCE WU-MBER
PLOT PLAN APPROVED
EXISTING STREET R/W �e ........ FT.
COMP. PLAN ST. R/W
WNECTION
'El OF CONSTR
I[] YES [] NO
PLAN CHECKED BY
REMARKS
Plan Check No ..... ...............
PROPOSED USE
0 LON NF—kc 1��'
Ae.;ItbackS,
BUILDING
PLUMBING
PLOT PLAN (Indicate abutting streets)
HEAT & GAS LINE
L
PENCE
LID
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITXON
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
formation given In 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-
lating construction; and In doing the work authorized thereby, no person
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
rolaUng to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS sball be com-
pleted In six months.)
DATE SIGNED
INSPECTION
DEPARTMENT
6s= xw 14,191
CITY OF
EDIMONDS
NVOTE: ApplicankSilbiect to Plan Check Fee
PR 6.1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curb&, sidewalks, driveways,
nutrquees, etc.) will require separate permission.
DEFICIENCY THIS PROPERTY
Z
CHECKED BY
LANCE
CE��
[j YES
No
Fee Receipt No.
S11. 154013�0 �
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.
DIRE S
..,��TORT I70NU
4`t:
Y.,
FILE
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